Health Policy Rollup: State Action We Watched in November 2025
Key Takeaways
Recent state health policy updates of note include the launch of a state public health alliance by fifteen governors to improve emergency preparedness and data sharing across state lines.
The Centers for Medicare & Medicaid Services announced all 50 states have applied for the Rural Health Transformation Program, which will distribute $50 billion in grants over five years.
California healthcare legislation 2025 features new laws to increase prior authorization transparency requirements, limit private equity influence in clinical decisions, and enhance oversight of pharmacy benefit managers.
Colorado’s proposed budget prioritizes Medicaid spending reduction, aiming to limit growth to $300 million next year to address concerns about rising costs.
Massachusetts advanced H. 4616 to require insurers to publish prior authorization requirements online and implement automated processing, while also releasing a roadmap to expand value-based care and health equity through the MassHealth waiver extension.
National Healthcare Policy Developments
Governors of fifteen states recently launched a public health alliance with the intent to improve public health coordination and emergency preparedness across state lines. In the Governors’ joint statement, it’s noted that the Alliance will serve as a hub for Governors and public health officials to share best practices, exchange data, and collaborate on emergency response, develop and respond to needed vaccine policy, and provide alignment on other technical issues. The Governors involved are from the states of Colorado, California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Carolina, Oregon, Rhode Island, Washington, and Guam.
The Centers for Medicare & Medicaid Services (CMS) announced that all 50 states had submitted applications for the Rural Health Transformation Program, a $50 billion grant program to be distributed to states over five years. Awards will be announced by December 31, 2025, with funding distributed over five years. $25 billion will be distributed equally across all fifty states, while the remaining $25 billion will be awarded through a merit review process by CMS.
California Healthcare Transparency and PBM Oversight
California Governor Newsom (D) signed several major healthcare bills. SB 306 boosts transparency by requiring health plans to report prior-authorization data and creates a “gold-carding” program that ends prior authorizations for services approved 90% of the time by no later than Jan. 1, 2028. SB 351 bars private equity–owned physician and dental practices from influencing clinicians’ medical judgment, coding, or billing decisions. SB 41 enhances oversight of PBMs. It requires that all PBMs in the state must be licensed by the Department of Insurance, mandates that PBMs pass rebates on to the payer or patient, prohibits PBMs from making exclusivity deals with manufacturers, and prohibits certain practices of PBMs.
Colorado Medicaid Budget Reduction Plans
Colorado Governor Jared Polis (D) recently released his proposed budget plan for the next fiscal year. A significant priority of the Governor’s is to reduce Medicaid spending in the state, noting in remarks during a recent press conference that Medicaid spending has increased at a rate of 8.8 percent per year, which is more than double the amount the state is allowed to increase total spending for the state per the state’s Taxpayers’ Bill of Rights. During the press conference, the Governor noted that the increased Medicaid costs on this trajectory would “crowd out” all other state activities. Specifically, the proposed plan calls for increasing Medicaid spending by only $300 million in the next fiscal year, $331 million less than what the state estimates is needed to cover increased projected costs if the state were to retain its Medicaid offerings as it currently stands.
Massachusetts Prior Authorization Reform and Medicaid Waiver Extension
The Massachusetts House Committee on Financial Services reported H. 4616 favorably out of committee. The bill would require insurers to publish on their website a list of all items, services, and medications that require prior authorization. The bill would also establish reporting requirements for insurers that must be sent to the state for review and require an insurer or utilization review organization to implement and maintain a prior authorization application programming interface (API) for automated processing of prior authorization requests.
Additionally, the Massachusetts Executive Office of Health and Human Services (EOHHS) has released a roadmap for the 2028–2032 MassHealth Section 1115 waiver extension, outlining the state’s goals to advance health equity, strengthen primary and behavioral care, and maintain near-universal coverage. The proposal emphasizes expanding value-based care through ACOs, addressing social drivers of health, and bolstering the provider safety net. MassHealth will hold two virtual public meetings on November 10 and November 17 to review the plan and gather stakeholder input.
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