Jan, 31, 2025

States of Innovation: January 2025

In January, several State-Based Marketplaces including Colorado, Maine, Maryland, Minnesota, Nevada, Pennsylvania and Washington announced that they concluded the 2024-2025 open enrollment period with record-breaking levels of enrollment, thanks to Marketplace innovations such as the federal enhanced premium tax credits, which are set to expire at the end of this year. Meanwhile, in advance of the transition in federal administration, a handful of states were approved for waiver amendments and requests, with California receiving approval for flexibilities to support Medi-Cal members and providers impacted by the Southern California wildfires, Idaho becoming the 48th state approved to provide postpartum coverage for 12 months, and Nevada approved to create a public option. 

January saw several states move to protect reproductive and women’s health, including Illinois prohibiting discrimination based on reproductive health decisions and Maryland enshrining reproductive freedom in the state’s constitution. States also continued to improve maternal health: Iowa Medicaid rolled out 12 months of postpartum coverage and Nebraska implemented its Medicaid Prenatal Plus program to reduce adverse birth outcomes.

States also focused on efforts to address healthcare costs and affordability, such as Colorado’s public option plan which has led to premium reductions across the individual market, while Massachusetts approved legislation to lower healthcare costs and strengthen oversight. Effective January 1, California’s legislation to prohibit medical debt from appearing on credit reports went into effect and Vermont proposed a plan to eliminate $100 million in medical debt. Action to expand access to care included New Mexico investing in rural healthcare providers, as well as efforts in Illinois, New York, Oregon, and Pennsylvania

Throughout January, states continued to focus on mental and behavioral health with Michigan issuing  grant funding for crisis response initiatives and Tennessee awarding grants to psychiatric hospitals across the state through its Medicaid program. States also took steps to increase access to services for children and youthIllinois launched a centralized resource for children and youth seeking mental health services and care and Minnesota’s Medicaid program implemented continuous enrollment for 72 months for all children under age six.

Affordability and Efforts to Address Cost

Colorado’s public option plans yield premium reductions in the individual market. The Colorado Division of Insurance is highlighting recent findings from a report that determined that the addition of Colorado Option plans to the state’s individual market led to premium reductions of over $100, even for non-option plans. The researchers note that these reductions are in stark contrast to other states, where health insurance premiums have increased by nearly 10% annually. The findings point to the potential for public option plans to offer more affordable premium options for people enrolled in the individual market, especially in places with high healthcare provider and hospital prices.

Massachusetts enacted legislation to lower healthcare costs and strengthen oversight. Governor Maura Healey signed into law S.3012 An Act relative to pharmaceutical access, costs, and transparency and H.5159 An Act enhancing the market review process, which seeks to lower healthcare costs, cap prescription drug costs at $25, improve access to primary care and increase oversight of the healthcare industry to protect patients and providers.

New Jersey’s Office of Health Care Affordability and Transparency will be moved under the authority of the Department of Health. Governor Phil Murphy signed Executive Order No. 377, directing the Office of Health Care Affordability and Transparency to be reestablished within the Department of Health, and transitioning leadership of the Health Care Affordability, Responsibility, and Transparency Program from the Department of Banking and Insurance to the Department of Health. The goal of the move is to support sustainable and continued implementation of the administration’s consumer-focused healthcare affordability work.

Pennsylvania is protecting consumers from excessive drug costs. The Pennsylvania Insurance Department (PID) established a new process for pharmacies to challenge a health benefit plan’s designation of a specialty drug, which is a critical protection provided by Act 77 of 2024. This referral process allows PID to ensure that pharmacy benefit managers and health insurers only label medications as specialty drugs when appropriate. This process will promote consistent coverage decisions on specialty drugs and protect Pennsylvanians from excessive costs and delays in receiving critical treatments.

Expanding Access to Care

Illinois issued a report on expanding access to sickle cell gene and cell therapy treatments. The Illinois Department of Healthcare and Family Services submitted to the governor and the general assembly its first report from the Advisory Council on Financing and Access to Sickle Cell Disease Treatment and other High-Cost Drugs and Treatment. The report evaluates various value and outcome-based payment approaches implemented in other states and includes recommendations for financing and increasing equitable access for these drugs in Illinois.

New Mexico is investing in rural healthcare providers. Governor Michelle Lujan Grisham announced that 26 additional rural healthcare providers will receive a combined $40.6 million from the Rural Health Care Delivery Fund, part of the $46 million allocated during the 2024 legislative session. Last fall, $5.4 million was awarded to four rural healthcare organizations that demonstrated their ability to immediately implement services. The funding supports a range of services statewide, including behavioral health, primary care, and maternal and child healthcare. These investments address rural health providers challenges, including geographic isolation and financial constraints.

New York is strengthening home care services for New Yorkers. Governor Kathy Hochul announced that New York state and Public Partnership LLC are partnering with 11 independent living centers as part of the state’s plan to strengthen the consumer directed personal assistance program for New York’s home care users. The statewide partnership includes independent living centers, disability-led non-profit organizations who have long served as advocates and champions for New Yorkers with disabilities living independent and self-directed lives. New York is also expanding access to care for children with complex disabilities. Governor Hochul announced the opening of The Center for Discovery’s Children’s Specialty Hospital, dedicated to supporting children and adolescents with complex disabilities, including autism, through specialized short-term inpatient care. Developed by The Center for Discovery’s multidisciplinary team in close partnership with the Office for People With Developmental Disabilities, it introduces a new care model focused on proactive treatments to reduce long-term residential placements.

Oregon is funding the rehab of housing to improve health. The Oregon Health Authority has awarded $23 million to the nine federally recognized tribes of Oregon and 34 local organizations to repair and rehabilitate homes of low-income residents to eliminate risks to residents’ health. Improved housing conditions for low-income families can prevent illness and reduce their healthcare costs, improve safety, conserve natural resources and reduce energy costs for occupants.

Pennsylvania helped consumers overturn denied healthcare claims. The Pennsylvania Insurance Department (PID) announced that through PID’s new independent external review process, 259 Pennsylvanians successfully appealed denied health service claims. In total, the external review process overturned 50.1% of appealed denials, helping to ensure more Pennsylvanians receive the health services they deserve.

Marketplace Innovations

Colorado’s open enrollment concluded with a 19% increase in enrollment. Connect for Health Colorado, the state’s official health insurance Marketplace, announced a record 282,483 Coloradans have enrolled in health insurance for plan year 2025, a 19% increase compared to the number who enrolled in 2024. Governor Polis and the Division of Insurance highlighted that Colorado Option enrollments accounted for nearly half of the state’s open enrollment activity. Colorado also announced it will receive $339 million in pass-through funding for its section 1332 waiver. The U.S. Department of Health and Human Services (HHS) and the Department of the Treasury announced that the Colorado Division of Insurance will receive $339 million in pass-through funding for the state’s section 1332 waiver. 

Maine ended open enrollment with a record number of 11,285 new enrollees. The Maine Department of Health and Human Services Office of the Health Insurance Marketplace announced that nearly 65,000 people signed up for coverage in 2025 through CoverME.gov, the state’s official health insurance Marketplace, during open enrollment. The state saw a record number of new enrollees, with 11,285 new consumers who previously did not have insurance through the Marketplace.

Maryland experienced a 16% increase in enrollment during open enrollment. The Maryland Health Benefit Exchange announced nearly 250,000 Marylanders enrolled for 2025 coverage through the state’s health insurance Marketplace, an increase of 16%  from last year. Enrollment among young adults ages 18 through 37 grew 21%, with more than two-thirds of the population eligible for Maryland’s young adult subsidy, which the General Assembly will consider making permanent this year.

Minnesota concluded a record-setting open enrollment with a 14% increase from last year. MNsure, the state’s official health insurance Marketplace, announced that over 167,000 Minnesotans signed up for 2025 health plans through the Marketplace, a 14% increase over last year.

Nevada reported over 110,000 people enrolled, the largest enrollment in the history of the Marketplace. Nevada Health Link, the state’s official health insurance Marketplace, announced it reached a record-setting open enrollment period with over 110,000 Nevadans enrolling in coverage. This year’s enrollment is about a 10% increase from last year.

New York published a report on health insurance coverage in the state. NY State of Health (NYSOH), the state’s official health insurance Marketplace, released the 2024 Health Insurance Coverage Update, a detailed summary of NYSOH enrollment. The report includes demographics, quality measures, a summary of unwinding activities, and an update on the first year of implementation of New York’s section 1332 state innovation waiver. The report highlights that as of September 2024, NYSOH enrollment is nearly 6.7 million, which means more than one in three New Yorkers across the state are enrolled in coverage through NYSOH.

Pennsylvania’s Marketplace saw a record-breaking open enrollment. Pennie, the state’s official health insurance Marketplace, concluded its 2025 open enrollment period with a record-breaking enrollment of 496,661, marking the largest Marketplace enrollment ever in the state.

Washington’s Marketplace exceeded 300,000 enrollments for the first time during open enrollment. The Washington Health Benefit Exchange announced that for the first time, enrollment in Marketplace plans through the state’s official health insurance Marketplace exceeded 300,000. This preliminary number includes people renewing their coverage and nearly 50,000 new enrollees.

Maternal Health

Illinois awarded grants for community-based efforts to provide maternity care . The Illinois Department of Public Health announced it has awarded $4.5 million to 12 groups across the state funded through Governor JB Pritzker’s 2024 Birth Equity Initiative. The grants, ranging from $100,000 to $700,000, are designed to support innovative, community-based efforts that have the potential to reduce inequities among populations historically at higher risk for adverse birth outcomes.

Iowa expanded postpartum Medicaid coverage for 12 months. Beginning January 1, 2025, eligible individuals can receive 12 months of postpartum coverage through Iowa Medicaid. Extending postpartum Medicaid coverage for 12 months can help lower the risk of pregnancy-related deaths and complications for the birthing parent. It can also help with ongoing care for chronic conditions such as diabetes, high blood pressure, heart disease, substance-use disorder and depression.

Nebraska is improving prenatal care coverage through Medicaid. The Division of Medicaid and Long-Term Care launched the Prenatal Plus Program, which supports Nebraska Medicaid-eligible pregnant people identified by their prenatal healthcare provider as being at risk for negative maternal or infant health outcomes. The program aims to reduce the incidence of low birth weight, pre-term birth, and adverse birth outcomes while addressing lifestyle, behavioral, and nonmedical factors that may impact the health and well-being of both parent and child.

New Jersey is examining the connection between food insecurity and maternal health. The New Jersey Department of Health published a new interactive report illustrating the connections between food insecurity and maternal and infant health challenges, as well as other community conditions that may affect related health outcomes. Using publicly available data, the report shows that maternal and infant health outcomes may be related to the lack of reliable access to healthy foods and other social, environmental, and economic factors that impact a person’s health.

New York became the first state to offer paid time off for medical care related to pregnancy. Beginning January 1, New York began offering paid time off for prenatal care or any medical care related to pregnancy. Under this policy, any privately-employed pregnant New Yorker will be able to receive an additional 20 hours of paid sick leave for prenatal care in addition to their existing sick leave, ensuring they can receive the care they need without putting their employment at risk.

Washington is providing coverage for doula services through Medicaid. The Washington State Health Care Authority (HCA) launched a new birth doula benefit on January 1, 2025. Birth doulas in Washington can now be reimbursed for services provided to Medicaid enrollees. The benefit launch follows a joint statewide recommendation for doula services from HCA and the Department of Health.

For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.

Medicaid Innovations

California is holding managed care plans accountable with quality ratings. The Department of Health Care Services (DHCS) published quality ratings for Medi-Cal managed care plans (MCP) and county behavioral health plans. Monetary sanctions are being imposed on MCPs that did not meet or exceed the established minimum performance levels, meaning the plans failed to provide members with a level of care that reached the quality standards established by DHCS. These actions are the result of the MCP contract, effective January 1, 2024, which strengthened quality requirements for MCPs.

Minnesota Medicaid is improving the health of American Indian communities. The Minnesota Department of Human Services has released a new state report, co-created with community leaders, with reflection, guidance and recommendations for action to better use Medicaid to support the health and wellbeing of American Indian communities. The report includes three main calls for action: invest in traditional healing, reframe definitions of health and well-being, and establish a Pathways to American Indian and Tribal Health Integration Team.

New Mexico created a new Office of Data Analytics. The New Mexico Health Care Authority (HCA) announced the launch of its new Office of Data and Analytics (ODA), dedicated to leveraging data-driven strategies to improve health outcomes across New Mexico. The ODA will also lead HCA’s evolution to using automation to provide guidance in decisionmaking.

Medical Debt

California’s law prohibiting medical debt from appearing on credit reports went into effect on January 1. California Attorney General Rob Bonta issued a consumer alert informing Californians that it is now illegal for most forms of medical debt to appear on credit reports due to legislation that went into effect on January 1, 2025. The law protects consumers from having their credit affected by medical debt appearing on credit reports. 

Vermont announced a proposal to eliminate $100 million in medical debt. State Treasurer Mike Pieciack announced a proposal to provide medical debt relief to thousands of Vermonters. The proposal would eliminate up to $100 million in medical debt for a one-time investment of $1 million dollars. The Office of the State Treasurer created a webpage with information about the proposal.

Federal regulators continue to act on medical debt as well. On January 7, the Consumer Financial Protection Bureau (CFPB) finalized a rule that bans the inclusion of medical bills on credit reports and removes an estimated $49 billion in medical bills from the credit reports of about 15 million Americans. CFPB is continuing to support states as they establish their own state laws and fortify protections for consumers against medical debt on credit reports, writing to state legislatures in Massachusetts, Oregon, South Dakota and Washington

For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar. SHVS also published a state spotlight profiling North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program.

Mental and Behavioral Health

California awarded more than $65 million to organizations for opioid treatment and recovery. The Department of Health Care Services awarded nearly $65.4 million to 91 organizations to strengthen the California Hub and Spoke System, a model designed to increase access to medications for opioid-use disorder services statewide. This funding will enhance prevention, treatment, and recovery services throughout the state.

Michigan will issue grants for community-based mobile crisis services. As part of efforts to expand behavioral health services for Michigan families, the Michigan Department of Health and Human Services (MDHHS) has issued a competitive grant funding opportunity for crisis response initiatives that would establish or expand community-based mobile crisis intervention services statewide. The purpose of this program is to increase behavioral health crisis services across the state for all Michigan residents, regardless of location, diagnosis or insurance status. 

Tennessee awarded grants to provide greater access to comprehensive psychiatric mental health services. TennCare, Tennessee’s Medicaid program, announced the awarding of grants to ten psychiatric hospitals across the state. Each hospital will receive $1.5 million annually for two years to support infrastructure improvements, workforce development, and enhanced clinical services to better care for child, adolescent, and adult TennCare members. The funding is provided through the state’s TennCare III Medicaid waiver. 

Preventing Gun Violence

New York announced gun violence declines in communities participating in the state’s gun violence elimination initiative. Governor Kathy Hochul announced that gun violence in communities participating in the state’s Gun Involved Violence Elimination (GIVE) initiative declined last year. Shooting incidents with injury declined 28% in 2024 compared to 2023, and the number of individuals injured declined 25%, with 238 fewer people harmed by gunfire.

For more information on gun violence prevention, check out this episode of the Princeton Pulse which discusses a public health approach focused on firearm safety and injury prevention.

Reproductive and Women’s Health

Illinois implemented legislation to protect reproductive health. Effective January 1, a new law went into effect that prohibits discrimination based on a person’s reproductive health decisions including fertility care and abortion. The law clarifies and extends existing protections in the Illinois Human Rights Act, ensuring Illinoisans have the right to engage in reproductive health decision-making without facing discrimination.

Maryland enshrined reproductive freedom into the state’s constitution. Governor Wes Moore signed a proclamation officially enshrining into Maryland’s constitution an individual’s fundamental right to reproductive freedom. The amendment follows Marylanders’ approval of a ballot initiative in November to enshrine abortion rights in the state’s constitution.

Michigan passed legislation expanding reproductive freedom and reducing barriers to affordable contraception. Governor Gretchen Whitmer signed 16 bills that will expand reproductive freedom in the state, including a bill that allows pharmacists to directly prescribe and dispense contraceptives to patients. These efforts follow an announcement by the MDHHS that the state will continue to offer free contraception supplies through the Take Control of Your Birth Control program and has distributed 34,300 doses of emergency contraceptive, 34,300 doses of oral birth control pills and 171,500 condoms to date. 

North Carolina’s governor issued an executive order to protect reproductive freedom. Governor Josh Stein announced an executive order to protect women’s reproductive freedom. The executive order directs cabinet agencies to safeguard medical privacy, ensures women receive accurate information about their pregnancies, and protects doctors providing lawful reproductive healthcare.

Washington will hold a strategic convening to protect access to reproductive healthcare. Governor Bob Ferguson signed an executive order directing the Department of Health to convene a roundtable of medical providers, reproductive health experts and policymakers to recommend strategies for protecting reproductive freedom in the state.

Services for Children and Youth

Illinois is increasing access to behavioral healthcare for children. Governor JB Pritzker and the Illinois Children’s Behavioral Health Transformation Initiative announced the public launch of the Behavioral Health Care and Ongoing Navigation (BEACON) care portal, a centralized resource for Illinois youth and families seeking youth mental health services and care, including state agency support and community-based programs.

Minnesota implemented continuous enrollment for youth enrolled in Medicaid. Beginning January 1, 2025, all children under age six who qualify for Minnesota Medicaid will have up to 72 months of uninterrupted coverage. Additionally, qualifying 19- and 20-year-olds will remain enrolled in Medicaid for 12 months. As a reminder, SHVS published a toolkit to support states in leveraging 12-month and multi-year continuous enrollment for Medicaid/CHIP-eligible children and youth to promote access to care, ensure delivery of critical preventive and behavioral health services, and monitor child health outcomes in partnership with key stakeholders.

New York is leveraging $10 million to support youth and teen mental health first aid. Governor Kathy Hochul announced that $10 million in state funding is available to offer a statewide Youth and Teen Mental Health First Aid program. The State Office of Mental Health will administer the funding to develop a training and certification program that helps New Yorkers identify, understand and respond to signs of mental illnesses and substance-use disorders in young people who may be experiencing a crisis.

Waiver and State Plan Amendments, Requests and Approvals

California received approval for several flexibilities to help Medi-Cal members and providers affected by the Southern California wildfires. In response to the Southern California wildfires, the Department of Health Care Services received approval of several dozen flexibilities to prevent disruptions in healthcare delivery so Medi-Cal members can continue to receive needed care. Key flexibilities of the 1135 waiver approvals include protections for Medi-Cal members, flexibility in provider enrollment and for home and community-based services, and support for clinics.

Idaho received approval to provide postpartum coverage for 12 months. CMS approved Idaho as the 48th state to extend postpartum coverage for a full year after pregnancy. Idaho’s approval marks 48 states, D.C., and the U.S. Virgin Islands that have extended postpartum coverage. As a reminder, SHVS published an issue brief on the American Rescue Plan Act option to extend postpartum coverage.

Maryland received approval to provide reentry services and expand housing supports. The Maryland Department of Health received CMS approval for reentry services and statewide expansion of housing supports. The first approval allows Maryland to provide targeted Medicaid services for incarcerated individuals who have substance-use disorders or serious mental illnesses up to 90 days before their release, starting July 1, 2025. The second approval enables the statewide expansion of the Assistance in Community Integration Services program, adding 1,240 participant spaces to provide housing and tenancy-based case management services.

Nevada received approval to create a public option. The Department of Health and Human Services (HHS) approved Nevada’s section 1332 waiver application, approving the state to sell public option plans, known as Battle Born State Plans (BBSPs), through the state’s Exchange. Under state law, BBSPs are required to reduce premiums by certain targets, including by at least 3% in 2026 and 15% by 2029. The state’s waiver also includes implementation of a premium relief program using reinsurance.

New York received an extension for the Essential Plan under the state’s section 1332 waiver. HHS approved an extension of New York’s section 1332 waiver for an additional year through plan yer 2029. As a reminder, SHVS published a state spotlight, New York’s Essential Plan Expansion: A Novel Use of Section 1332 Waiver Authority, which highlights the program to provide premium-free coverage with minimal cost-sharing for individuals with incomes up to 250% of the federal poverty level.

Oregon was approved to expand Medicaid coverage and enhanced benefits to more young adults. Oregon received approval of a waiver to test whether increasing access to affordable care for young adults with complex healthcare needs will improve health outcomes. The Young Adults with Special Health Care Needs benefits extend Medicaid coverage, enhanced vision and dental services and the new health-related social needs climate and housing benefits to young adults ages 19 and 20 with special healthcare needs.