States of Innovation: March 2025

While Congress advanced the budget reconciliation process in March, states continued to emphasize the value of Medicaid, highlighting the impact of potential federal changes to Medicaid on the health and wellbeing of their residents and healthcare providers. Four states–Illinois, Minnesota, New Jersey and North Carolina–hosted roundtables with stakeholders and individuals who receive their health coverage through Medicaid, while Kentucky and New Mexico published estimates of the impact of proposed federal changes. States are also highlighting the need for action to extend the federal enhanced premium tax credits set to expire at the end of 2025. The 19 states with State-Based Marketplaces highlighted the benefits of the enhanced subsidies in a letter to Congress. Other states advocating to extend Marketplace affordability include Oklahoma, Colorado and Pennsylvania. 

Other state action in March included New York launching a new online portal to file complaints about prescription drugs in an effort to address affordability and cost. On the topic of community engagement, Michigan started recruiting members for the state’s new Beneficiary Advisory Council and Nebraska is surveying residents to identify emerging health concerns. California, Connecticut, New Jersey and Oregon took steps to expand access to care while Rhode Island highlighted its record-breaking Marketplace enrollment. California highlighted a new Marketplace innovation effort that will reinvest funds from underperforming health plans to benefit enrollees. 

March saw states continuing to work on maternal and infant health: Louisiana is recruiting providers for a learning collaborative on perinatal depression and New Jersey awarded funding to start-ups to address maternal and infant health. Efforts focused on reproductive and women’s health included Massachusetts increasing access to perinatal vitamins and oral contraceptives. In terms of Medicaid innovations, Nevada announced a new centralized credentialing process for providers while Oregon is offering technical assistance to providers in support of health-related social needs implementation. Rhode Island announced it has forgiven a total of $7 million in medical debt since launching a relief program in October. 

Mental and behavioral health continues to be an area of high activity for states: California, Montana, New Mexico, New York and Wyoming announced new initiatives or funding. On the topic of services for children and youth, North Carolina is rolling out virtual mental healthcare for students, while North Dakota is inviting public comments on new priorities for children’s health. 

Two states announced they are seeking approval of waivers from CMS, including Ohio, which is seeking to implement continuous enrollment for children until the age of four. North Carolina received approval for a public health emergency 1115(a) waiver in the aftermath of hurricane Helene.  

Affordability and Efforts to Address Cost

New York launched a new online portal to file complaints about prescription drug price increases. Governor Hochul announced the launch of DFS Connect, a new digital program that will provide a streamlined and transparent way for individuals to file complaints for prescription drug prices that increase more than 50% over the course of a year. Pharmacies will also be able to report problematic business practices of pharmacy benefit managers and drug manufacturers.

Community Engagement

Michigan announced it is recruiting members for its Beneficiary Advisory Council. The Michigan Department of Health and Human Services is seeking members for the Beneficiary Advisory Council (BAC), a new committee that will allow Michigan Medicaid members to share experiences about services received through Medicaid. As a reminder, SHVS published template materials designed to support state agencies in recruiting members for the BAC. States can customize the content of the materials, which include a recruitment flyer, social media graphics, core messages, website copy, and newsletter copy.

Nebraska is surveying residents to learn more about factors affecting health in the state. The Nebraska Department of Health and Human Services is inviting residents to participate in the Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS collects data on health-related risk behaviors and events, chronic health conditions, and use of preventive services. Information gathered during these surveys is used to identify emerging health problems, establish and track health objectives, and develop, implement, and evaluate a broad array of disease prevention activities in the state.

Expanding Access to Care

California applied to participate in the Cell and Gene Therapy Access Model. The Department of Health Care Services (DHCS) applied to the Center for Medicaid and Medicaid Innovation (CMMI) to participate in the Cell and Gene Therapy Access Model. If approved, this multi-year initiative will expand Medi-Cal members’ access to lifesaving gene therapies for sickle cell disease, a severe genetic blood disorder that disproportionately affects people of African descent. 

Connecticut is offering free training to become a licensed health insurance broker. Access Health CT, the state’s official health insurance Marketplace, announced that applications opened for the 2025 Broker Academy Program. This free program recruits and trains individuals from marginalized communities in Connecticut, to become licensed health insurance brokers. The program aims to help reduce health disparities and uninsured rates and increase trust in the healthcare system by embedding these professionals in the state’s hardest-to-reach areas.

New Jersey is reminding residents about easy enrollment. New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman is reminding New Jerseyans without health insurance that they can connect with Get Covered New Jersey, the state’s official health insurance Marketplace, when they file their 2024 State Income Tax return. Residents without health insurance can complete the NJ-EZ Enroll Form to connect to the Marketplace, which will send consumers a welcome notice with an access code to access their account and enroll in coverage.

Oregon is seeking public comments on expanding its Basic Health Program. The Oregon Health Authority (OHA) has opened a public comment period on new edits to its existing 1331 Basic Health Program (BHP) Blueprint. OHA is requesting to offer retroactive coverage to a limited number of individuals who meet certain circumstances and were determined eligible for the BHP and a continued exception to the federal requirement to offer a choice of standard health plan offerings to OHP Bridge enrollees.

Extending Marketplace Affordability

Colorado’s Marketplace highlighted how Coloradans have benefitted from premium tax credits. Kevin Patterson, CEO of Connect for Health Colorado, the state’s official health insurance Marketplace, and Michael Conway, Colorado Insurance Commissioner, celebrated 15 years of the Affordable Care Act (ACA) by co-authoring an opinion column. The column includes stories from Coloradans who have benefitted from the ACA and discusses the importance of Congressional action to extend the enhanced premium tax credits which make coverage more affordable. SHVS Director Heather Howard also marked the 15th anniversary of the ACA, the landmark legislation that fundamentally transformed our healthcare system, in an op-ed. 

Oklahoma is warning about an increase in premiums if tax credits are not extended. Oklahoma Insurance Department Commissioner Glen Mulready is alerting Oklahomans enrolled in ACA Marketplace plans that they could see substantial increases in premiums beginning in 2026 if the federal enhanced premium tax credits are not renewed. The state anticipates the average cost of a benchmark silver plan in Oklahoma to increase by 65% which could lead to a significant reduction in the number of insured individuals in the Marketplace, and lead to adverse selection further driving up rates.

Pennsylvania is calling for federal action to renew premium tax credits. The Pennsylvania Insurance Department, the Department of Human Services, and Pennie–Pennsylvania’s official health insurance Marketplace–celebrated the Affordable Care Act’s 15th anniversary and called for federal action to renew tax credits set to expire at the end of 2025.

Nineteen states with State-Based Marketplaces highlighted the benefits of the enhanced subsidies in a letter to Congress. The executives of 19 State-Based Marketplaces sent a letter to Congress to share their collective experiences that emphasize the value and benefit of the enhanced premium tax credit structure set to expire at the end of this year. The letter notes that the window for action to extend the subsidies is closing, as preliminary rates will begin being released soon.

Highlighting the Value of Medicaid

Illinois convened community members to highlight the potential impact of proposed changes to Medicaid. Governor Pritzker attended a community meeting where advocates, providers, and patients shared their stories on the importance of protecting Medicaid, and the negative impact that cuts would have on their lives. One in four Illinoisans, over 3.4 million people, receive healthcare coverage through Medicaid and are at risk of losing access or seeing their premiums increase under proposed cuts. This includes coverage for nearly half the state’s children, many people with disabilities, and those living in senior or long-term care facilities. ​

Kentucky published a chart book on Medicaid and the potential impacts of proposed federal changes. The Kentucky Cabinet for Health and Family Services published a chart book that details who is served by Medicaid in Kentucky, what services and benefits are covered, and how much funding the state receives from the federal government. The chart book reviews the potential impact of the various federal changes under consideration by Congress with estimates by county and hospitals. 

Minnesota is hosting a series of roundtables on the changes to Medicaid being debated in Congress. The Department of Health Services launched a series of statewide roundtables educating Minnesotans on the impact of proposed federal cuts to vital healthcare programs. The series launched at Children’s Minnesota Hospital with a meeting of state officials, doctors, patients and advocates highlighting state estimates that Minnesota could lose as much as $1.6 billion annually in federal support for healthcare programs serving a wide swath of Minnesotans, including children, those who are pregnant, seniors and people with disabilities.

New Jersey held a roundtable to hear from Medicaid members how they would be affected by changes to the program. Governor Phil Murphy hosted a roundtable discussion with Medicaid enrollees whose lives would be negatively impacted by potential federal funding cuts to Medicaid. NJ FamilyCare provides comprehensive healthcare coverage to 1.8 million New Jerseyans, including children, working families, older adults, and individuals with disabilities. The roundtable discussion provided an opportunity to hear directly from those who would be most impacted by Medicaid cuts being discussed at the federal level. As a reminder, the New Jersey Department of Human Services has modeled the impact NJ Medicaid of Congressional budget proposals. 

New Mexico published estimates of proposed federal changes to Medicaid. The Health Care Authority published a fact sheet that shares high level information about who receives health coverage through Medicaid in the state by county as well as by diagnosis. The fact sheet includes several graphics illustrating the cascade effect on hospitals and New Mexicans of cutting Medicaid as well as the estimated impact of the various proposals being discussed in Congress. 

North Carolina hosted a roundtable discussion on proposed federal changes to Medicaid and released a fact sheet. Governor Josh Stein and the North Carolina Department of Health and Human Services Secretary Dr. Dev Sangvai hosted a roundtable to highlight the potential damaging impacts of proposed federal Medicaid cuts. Healthcare professionals and Medicaid enrollees discussed the lifesaving impacts of Medicaid and the importance of protecting Medicaid funding from federal cuts. Additionally, the North Carolina Department of Health and Human Services released a fact sheet on the impact of Medicaid, highlighting the populations covered by Medicaid, such as rural communities and veterans, and describing how proposed federal changes will hurt North Carolinians. 

Pennsylvania highlighted its success in preventing Medicaid fraud. The Secretary of Human Services, Dr. Valerie Arkoosh, highlighted the state’s success addressing Medicaid fraud in the Commonwealth with the partnership of State Inspector General Michelle Henry. Pennsylvania leads all states in the number of cases referred for prosecutorial investigation and saved nearly $500 million in expenditures by reviewing third-party liability.

SHVS is tracking the states that are publicly reporting their estimates of proposed cuts to Medicaid. The expert perspective highlights state agencies that have estimated and quantified the potential impacts of various proposals on enrollment and spending. SHVS will continue to regularly monitor published estimates from states and update the expert perspective.

Marketplace Enrollment

Rhode Island enrolled a record breaking number of people in coverage. HealthSource RI (HSRI), the state’s official health insurance Marketplace, announced it concluded its annual open enrollment period on February 28, with its highest ever open enrollment total of 42,695. The open enrollment period was extended by one month this year to provide access to customers after a cybersecurity incident in December. HSRI highlighted the importance of the enhanced premium tax credits to improve affordability, which are set to expire in December without federal action.

Marketplace Innovations

California is reinvesting funds from underperforming health plans to benefit enrollees. Covered California, the state’s official health insurance Marketplace, announced the launch of an initiative that will reinvest dollars collected from underperforming health plans to benefit enrollees’ wellness. Known as the Population Health Investments (PopHI) program, the investments will fund programs to help enrollees with chronic health conditions and financial challenges access nutritious food, improve childhood immunization rates for children under two, invest in children’s future higher education expenses and accelerate population-health management capabilities in primary care practices.

Maternal and Infant Health

Louisiana is recruiting providers to participate in a learning collaborative on perinatal depression screening. The Louisiana Perinatal Quality Collaborative is recruiting pediatric providers, including family practices that provide care for infants, to participate in the next 10-month Caregiver Perinatal Depression Screening (CPDS) Learning Collaborative. The CPDS Learning Collaborative is focused on perinatal depression screening in pediatric practices and identifying resources for those who screen positive.

New Jersey awarded funding to start-ups to address maternal and infant health. First Lady Tammy Murphy and New Jersey Economic Development Authority CEO Tim Sullivan announced the Commission on Science, Innovation, and Technology awarded a combined $1.7 million in grants to 23 New Jersey-based start-ups focused on developing technology, therapeutics, and other solutions to address maternal and infant health challenges. The grant funds support the research and development of products, and services to enhance the quality of care and service delivery activities to women, infants, and healthcare agencies.

Medicaid Innovations

Nevada is implementing a new centralized credentialing process for providers. The new centralized credentialing process will speed up, consolidate and accurately verify the information healthcare providers submit to legally administer medical care in the state. Prior to centralized credentialing, providers who wanted to serve Medicaid members through a health plan in certain counties had to credential with each health plan. Providers will still need to go to each health plan to initiate credentialing and contracting, but this process will streamline the credentialing step through one vendor.

Oregon is offering technical assistance to providers who address health-related social needs (HRSN). The Oregon Health Authority announced a new Learning Collaborative Technical Assistance series for HRSN providers and coordinated care organizations, to support the implementation of HRSN benefits. 

Medical Debt

Rhode Island has forgiven over $7 million in medical debt. Rhode Island General Treasurer James A. Diossa announced that over $7 million in medical debt held by Rhode Islanders has been forgiven through the state’s medical debt relief program since its launch in October. Nearly 3,000 individuals have benefited from the initiative, which has leveraged $50,000 to purchase medical debt from providers.

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 is piloting emergency medical service providers rendering substance-use disorder treatment in the field. To meet patients where they are, DHCS awarded $800,000 to two emergency medical service agencies to increase access to clinically proven opioid-use disorder treatment for patients who are at risk of overdose. The grants will enable the two agencies to address substance-use disorder as a treatable emergency condition, utilizing paramedics to identify and treat patients who would benefit from medications for substance-use treatment and often do not have access to services in other settings.

Montana is expanding peer support services. Governor Greg Gianforte announced a $700,000 investment to expand peer support services, specifically for families and caregivers of youth with serious emotional disturbance. Family peer support services are provided by those who have lived experience raising a child with behavioral health challenges or special healthcare needs and are equipped to provide emotional support and resources to another family who is raising a child with similar needs. 

New Mexico is supplying local offices with Narcan. The New Mexico Health Care Authority (HCA) is equipping all Income Support Division offices with naloxone. New Mexico residents can apply for various benefits and assistance at Income Support offices across the state. HCA will also train staff to help prevent opioid overdoses and save lives.

New York is funding five “step-down” programs to support transitions back to the community. Governor Kathy Hochul announced awards to establish five step-down programs to help adults living with co-occurring mental illness and intellectual or developmental disabilities safely transition back into their community. Administered by the State Office of Mental Health, the $85 million in funding over five years will help service providers develop enhanced ‘step-down’ programs that couple critical intervention teams with transitional housing to ensure individuals can live in independent settings once they are discharged from a hospital or other inpatient settings.

Wyoming launched a video series to support discussion of mental health. The Wyoming Department of Health (WDH) launched a video series to help lead workplace discussions on substance-use and mental health. Known as “Let’s Talk Wyoming,” the short, informative videos are free to watch and share online at LetsTalkWY.org, which is included on the WDH website.

Reproductive and Women’s Health

Massachusetts is increasing access to prenatal vitamins and oral contraception. The Healey-Driscoll administration announced two standing orders that will allow eligible Medicaid enrollees and other qualifying patients to access prenatal vitamins and over the counter oral contraceptives at no cost. The medications in the standing orders will be available through all Medicaid enrolled pharmacies, and pharmacists will be required to provide counseling or guidance on the proper use of both products. 

New York strengthened its shield law to protect abortion providers. Governor Kathy Hochul signed legislation to strengthen New York’s shield law that protects abortion providers from out-of-state prosecution. The bill enhances New York’s current shield law to allow medical providers to include only the address of the dispensing healthcare practice on the prescription label instead of the name of the provider or practice and requires pharmacies to abide by a prescriber’s request to remove their name from the prescription label.

Services for Children and Youth

North Carolina is rolling out virtual mental healthcare for K-12 students. The North Carolina Department of Health and Human Services announced students across the state will soon have access to virtual mental healthcare through Hazel Health. Once Hazel is implemented, any student who is enrolled within participating districts will be able to access one of Hazel’s on-staff, licensed therapists before, during and after the school day.

North Dakota is inviting public comment on new priorities for maternal and child health. The North Dakota Health and Human Services completed its five-year needs assessment to identify new or emerging priorities for the maternal and child health population and is inviting public comment on the draft priorities. The following priority areas were identified: 1) identify, reduce or eliminate barriers preventing women from receiving recommended postpartum care; 2) use statewide resources to educate about and implement infant safe sleep best practices; 3) expand partnerships with existing community resources to improve access to healthy food options; 4) improve care coordination to link the pediatric population to essential services and resources; 5) identify, reduce or eliminate barriers preventing adolescents from receiving mental health treatment and counseling; and 6) improve the system of care for children with special healthcare needs.

Waiver and State Plan Amendments, Requests and Approvals

Idaho is requesting to extend and expand its behavioral health transformation section 1115 waiver. Idaho submitted an application requesting to extend the Idaho Behavioral Health Transformation section 1115 demonstration for five years. The state is requesting to extend residential and inpatient treatment for individuals with a substance-use disorder and/or serious mental illness and to add a new expenditure authority for the Youth Empowerment Services Group—a home and community-based services section 1915(i) group.

North Carolina received approval for a public health emergency 1115(a) waiver. CMS approved “North Carolina Hurricane Helene Public Health Emergency Section 1115(a) Demonstration.” Under the demonstration, the state will receive expenditure authority to provide retainer payments to 1905(a) personal care service providers to serve as relief for those experiencing decreases in utilization and temporary practice closures. The demonstration also grants expenditure authority to provide Healthy Opportunities Pilots services to eligible enrollees, regardless of whether they temporarily evacuated the pilot region due to the hurricane.

Ohio is applying for a waiver to implement continuous enrollment for children until age four. The state provided public notice of its intent to submit an application for a section 1115 waiver to provide continuous enrollment for children through the end of the month in which their fourth birthday falls. As a reminder, SHVS published a toolkit for states to leverage 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.