States of Innovation: October 2024

In October, states took action on affordability and efforts to address cost: Colorado published a new tool to increase hospital price transparency, while New Jersey adopted rules to promote prescription drug price transparency. As states with approved section 1115 waivers to provide coverage for justice-involved populations prior to their release roll out implementation, California began delivering pre-release services to people returning to their communities after incarceration in three counties. To expand access to care, Maryland is piloting the use of drone technology to improve rural access to healthcare resources, while Michigan enacted legislation to support access in rural communities by amending restrictions on funding for hospitals. 

States also focused on advancing health equity: Illinois hosted a Minority Health conference and New York’s official health insurance Marketplace highlighted its health equity initiatives. In terms of Marketplace innovations, Alaska, the District of Columbia, and Washington received approval to expand coverage for services through essential health benefits benchmark plans. 

States continue to tackle maternal health, including Massachusetts, which announced grant funding for freestanding community birth centers, and Michigan where the governor signed legislation to strengthen protections against discrimination for individuals who are breastfeeding and expand Medicaid coverage for birth expenses. States also took action to address medical debt in October: New Jersey announced a second round of medical debt elimination and has eliminated $220 million in medical debt to date. 

Throughout the month of October states took action on mental and behavioral health, such as Michigan, which announced it will pilot recovery incentives for individuals living with a substance-use disorder who meet treatment goals. New York enacted legislation to strengthen its gun safety laws and prevent gun violence. 

Also in October, in an effort to protect reproductive and women’s health, Nebraska expanded access to screening for breast and cervical cancers. State action to improve services for children and youth included Pennsylvania requiring health insurance coverage for speech therapy for children. 

Lastly, states received approval from the Centers for Medicare & Medicaid Services (CMS) for waiver and state plan amendments and requests. Arizona officially launched its Housing and Health Opportunities program which operates under the state’s section 1115 demonstration and aims to expand housing services for specific members experiencing homelessness. Louisiana and Michigan submitted requests for section 1115 demonstrations to provide pre-release services for individuals leaving incarceration. 

Affordability and Efforts to Address Cost

Colorado launched a tool to increase hospital price transparency. Governor Polis and Lieutenant Governor Primavera announced the launch of the Colorado Hospital Price Finder, a tool to increase price transparency. The tool complements the state-generated price transparency initiative announced earlier this year and provides Coloradans the ability to research all available prices at every hospital and shop for the care that works for individuals and families. The tool shows the total price that the hospital charges each payer, although the final amount charged to Coloradans depends on each person’s insurance plan and coverage. 

Colorado announced that reinsurance will save Coloradans millions. Governor Jared Polis and the Colorado Division of Insurance announced that reinsurance will save Coloradans almost $493 million on approved plans and premiums for 2025. Colorado Option plans will continue to offer savings for enrollees, with an average premium change of 4.6% for Colorado Option plans compared to an average increase of 6.1% for non-Option plans.

New Jersey is promoting transparency in prescription drug pricing. Attorney General Matthew J. Platkin and the Division of Consumer Affairs announced new adopted rules promoting greater transparency in prescription drug pricing. The new rules establish registration, reporting and compliance requirements across the prescription drug supply chain. The Division will use this information to produce an annual report on emerging trends in prescription drug prices, used to help the newly created Drug Affordability Council formulate legislative and regulatory policy recommendations focused on prescription drug affordability.

Coverage for Justice-Involved Populations

California began delivering pre-release services to individuals leaving incarceration. The Department of Health Care Services announced that three California counties—Inyo, Santa Clara, and Yuba—were approved as of October 1 to begin delivering a targeted set of Medicaid services to people returning to communities after incarceration. All California counties are required to implement this initiative as of October 1, 2026.

Mississippi is collecting feedback from carceral facilities to prepare for providing Medicaid and CHIP services to incarcerated children and youth. In preparation for implementation of the new Consolidated Appropriations Act, 2023 requirements regarding the provision of Medicaid and CHIP services to incarcerated children and youth, the Mississippi Division of Medicaid created an online survey to collect feedback from affected carceral facilities and released a fact sheet.  

Expanding Access to Care 

Maryland is piloting the use of aviation technology to improve rural access to healthcare resources. Governor Wes Moore announced that the U.S. Department of Transportation has awarded the Maryland Department of Planning a $1.76 million SMART grant to pilot the use of aviation technology. The program will focus on improving access to healthcare resources in rural communities on Maryland’s eastern shore.

Michigan enacted legislation to expand access to healthcare. Governor Gretchen Whitmer signed bills to expand access to healthcare and protect healthcare workers. Senate Bill 929 repurposes Medicaid funding to allow low-income Michiganders access to a broader range of care centers; Senate Bill 701 supports access in rural Michigan by amending restrictions on the funding Michigan hospitals can receive; and Senate Bills 790 and 791 allow individual home help caregivers to unionize.

Health Equity

California Medicaid hosted a training to support providers’ competency in transgender and gender diverse health. On October 29, the Department of Health Care Services and the California Prevention Training Center hosted the Chosen Family: Contraception for Transgender and Gender Diverse People webinar. Transgender and gender diverse (TGD) people represent a growing subset of patient populations, yet many continue to report a lack of provider knowledge when it comes to TGD health. The webinar aimed to build upon TGD health terminology and competency essentials by reviewing evidence-based recommendations for contraceptive counseling. 

Illinois hosted a Minority Health Conference. Governor JB Pritzker and the Illinois Department of Public Health (IDPH) kicked off a three-day Minority Health Conference. IDPH is working to implement the Healthy Illinois 2028 State Health Improvement Plan, one of the key pillars of addressing structural racism as a public health crisis. 

New York’s Marketplace published a portfolio outlining its health equity initiatives. NY State of Health (NYSOH), the state’s official health insurance Marketplace, released a Health Equity Portfolio which outlines health equity initiatives currently underway in the Marketplace, reports on the efforts of the health equity workgroup, and identifies potential interventions and policies to help New York become a more equitable health landscape. By grounding its efforts in health equity, NYSOH aims to reduce the number of uninsured New Yorkers, expand access to healthcare services, and improve health outcomes for all New Yorkers. 

Marketplace Innovations

Alaska, the District of Columbia, and Washington received approval to expand coverage for services through essential health benefits benchmark plans. CMS approved essential health benefits benchmark plan applications for plan year 2026 and beyond for Alaska, the District of Columbia, and Washington. Alaska received approval to add coverage for hearing aids, massage therapy, nutritional counseling, chiropractic and temporomandibular joint disorder care. The District of Columbia received approval to expand coverage for infertility treatments, and Washington received approval to expand coverage for human donor milk, hearing aids, and artificial insemination. 

New York announced approval of a section 1332 waiver amendment that will result in out-of-pocket savings. The state announced the approval of an amendment to its section 1332 waiver that will result in out-of-pocket savings of $307 million for 117,000 New Yorkers in 2025. As a reminder, SHVS published a state spotlight highlighting New York’s novel use of section 1332 waiver authority to provide coverage for low-income residents up to 250% of the poverty level, including Deferred Action for Childhood Arrivals recipients, with no premiums and minimal cost-sharing requirements.

Maternal Health

Arizona Medicaid began reimbursing for doula services. The Arizona Health Care Cost Containment System (AHCCCS) announced it will reimburse for Medicaid members who use doula services. Doula reimbursement is available to any doula certified through the Arizona Department of Health Services’ voluntary doula certification program and registered with AHCCCS as a provider.

Massachusetts is funding freestanding community birth centers. The Healey-Driscoll administration announced $1 million in grants to increase capacity and accessibility for freestanding community birth centers. The grants will support the development and operation of birth centers by covering facility costs, start-up expenditures, and the provision of comprehensive prenatal and postpartum care.

Michigan enacted legislation to protect individuals who are breastfeeding and expand coverage for birth expenses. Governor Gretchen Whitmer signed a package of bills to expand access to healthcare, including Senate Bill 351 to strengthen protections against discrimination for individuals who are currently breastfeeding and Senate Bill 928 which eliminates a clause that prevents Medicaid from fully covering birth expenses. 

Michigan is also increasing Medicaid reimbursement for doula services. The Michigan Department of Health and Human Services issued a bulletin updating Medicaid coverage and reimbursement of doula services. Under the new policy, the total number of covered doula visits will increase to 12 per pregnancy, the reimbursement rate for labor and delivery support will increase to $1500, and the visit reimbursement rate will increase to $100. 

Missouri Medicaid will begin reimbursing for doula services. The Missouri Department of Social Services’ MO HealthNet Division, which administers the state’s Medicaid program, announced that CMS approved a state plan amendment that enables the state to begin reimbursing for doula services. A forthcoming provider bulletin will provide details on Medicaid billing, service definitions, and reimbursement rates. 

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. 

New York enacted legislation to support maternal health. Governor Kathy Hochul signed a legislative package to support maternal health: S.201/A2656 permits pregnant individuals to enroll in health insurance at any time without penalty; S.1965-A/A.3865-A requires commercial insurers to cover prenatal vitamins when prescribed by a practitioner; and S.6674-A/A.7790-A expands insurance coverage requirements for human donor milk to outpatient settings. 

Medical Debt

New Jersey announced a second round of medical debt elimination and has eliminated $220 million in medical debt to date. Governor Phil Murphy announced the state’s second round of medical debt elimination, totaling $120 million in debt abolished for 77,000 New Jerseyans. For this round, the state is leveraging $900,000 in American Rescue Plan funds and is working with the Atlantic Health System to identify and purchase qualifying medical debts. Through the state’s partnership with Undue Medical Debt, $220 million has been eliminated for 127,000 residents to date. 

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 recent 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 on North Carolina’s comprehensive medical debt relief and reform incentive program.

Mental and Behavioral Health

Hawai’i created a webpage to facilitate individuals filing assisted community treatment petitions. The Department of the Attorney General announced the launch of a webpage for those who seek the department’s help with filing assisted community treatment (ACT) petitions in family court, to provide treatment for those with serious mental illnesses or substance-use that can render them dangerous to themselves or others. In 2024, the Legislature provided that the Department of the Attorney General assist with the preparation and filing of ACT petitions and with the presentation of the case at any related court proceeding. The department’s new ACT webpage includes forms and instructions that will facilitate this process, including legal definitions and ways of submitting the necessary information to the department.

Montana is investing in the behavioral health needs of rural and tribal communities. Governor Greg Gianforte announced an investment of up to $2.5 million to support rural counties and tribal communities as they design and implement targeted, locally-developed solutions to behavioral health needs within their communities. The investment represents the next allocation of $300 million in funding secured by the governor last year to reform and improve Montana’s behavioral health and developmental disabilities services systems.

Michigan will pilot recovery incentives for individuals living with a substance-use disorder who meet treatment goals. The Michigan Department of Health and Human Services is contracting with CHESS Health to provide an automated incentive manager solution as part of the state’s Recovery Incentives Pilot. The Recovery Incentives Pilot will offer eligible Medicaid enrollees contingency management, an evidence-based treatment that provides motivational incentives to people living with a substance-use disorder and who are able to meet treatment goals. Incentives will be delivered through a reloadable debit card that can be used to purchase goods and services.

New Jersey is allocating opioid settlement funds to support additional efforts tackling the opioid crisis. Governor Phil Murphy announced the allocation of more than $25 million from New Jersey’s Opioid Recovery and Remediation Fund to support efforts tackling the opioid crisis, including expanding legal services for those in recovery, enhancing youth substance-use treatment and prevention, and boosting emergency response efforts. The newly allocated funding builds upon more than $95 million in opioid settlement spending announced earlier this year.

Oregon created a dashboard to track progress towards additional behavioral health residential treatment beds. Governor Tina Kotek and the Oregon Health Authority announced a residential treatment capacity dashboard to track the state’s progress towards additional behavioral health residential treatment beds and recovery housing units, with the projected goal of adding 465 beds by December 2026. The dashboard includes existing capacity, added capacity based on existing provider contracts, and projected capacity based on contracts in development across bed types. 

Preventing Gun Violence

New York is strengthening its gun safety laws. Governor Kathy Hochul signed a package of six bills intended to strengthen New York’s gun laws. The legislative package requires gun sellers to post tobacco-style safety warnings, taking action against dangerous “pistol converters” and provides other new tools and resources to help protect more New Yorkers from gun violence. 

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

Michigan is expanding access to free contraception and family planning educational resources. Governor Gretchen Whitmer announced a new program, “Take Control of Your Birth Control” to ensure Michigan families have access to free contraception including over-the-counter oral birth control pills, emergency contraception, condoms, and family planning educational resources through community partners and federally qualified health centers during the month of November. The program is funded using $5.6 million secured in the state’s budget to support family planning. 

Nebraska expanded access to screening for breast and cervical cancers. The Every Woman Matters (EWM) program has lowered the enrollment age to 21 and increased the eligibility income level to 250% of the federal poverty level to provide broader access to women most in need. The EWM program provides screening for breast and cervical cancers, and women who enroll may be eligible for a pelvic exam, Pap test, clinical breast exam, and screening mammogram based on family or personal history.

New York enacted legislation to expand coverage for breast cancer screening and imaging. Governor Kathy Hochul signed S.2465C/A.1696C which requires individual, group, and non-profit health insurance plans to cover breast cancer screening and diagnostic imaging.

Services for Children and Youth

Pennsylvania is requiring health insurance coverage for children’s speech therapy. Governor Josh Shapiro signed a bill into law ensuring health insurance coverage for speech therapy for children who stutter. The law requires health insurance companies to cover speech therapy for children aged two to six diagnosed with stuttering, offering financial relief to families. 

Waiver and State Plan Amendments, Requests and Approvals

Arizona launched a program to expand housing services through its section 1115 demonstration. The Arizona Health Care Cost Containment System (AHCCCS) officially launched its Housing and Health Opportunities (H2O) program. The initiative, which operates under the state’s 1115 research and demonstration waiver, aims to expand housing services for specific AHCCCS members experiencing homelessness. Starting October 1, the H2O program will focus on AHCCCS members with a Serious Mental Illness designation who are also experiencing homelessness or housing instability and have an identified chronic health condition or experienced justice involvement within 90 days.

Louisiana is seeking approval to provide pre-release services for individuals leaving incarceration. 

The state submitted a request for a new five-year Medicaid section 1115 demonstration entitled “Louisiana Reentry Demonstration.” This demonstration aims to provide Medicaid coverage to qualified individuals prior to their release from prison or jail. The state seeks to cover Medicaid services, including case management, medication-assisted treatment, and a 30-day supply of prescription drugs, among other services. 

Michigan is seeking approval to provide pre-release services for individuals leaving incarceration. The state submitted a request for a new Medicaid section 1115 demonstration entitled “Reentry Services Demonstration.” The demonstration includes coverage for certain pre-release services to eligible individuals who are incarcerated in state prisons, local county jails, and/or juvenile facilities and who are returning to the community.