Five State Health Policy Developments in April 2026

Key Takeaways

• The Supreme Court ruled 8-1 that Colorado's conversion therapy licensing laws must face strict scrutiny review, finding that states cannot use licensing power to restrict what therapists discuss with clients under the First Amendment.
• Kansas enrolled SB 20, which would impose pharmacy benefit manager regulations requiring a $10.50 dispensing fee and rebate disclosure, joining Arkansas and West Virginia in regulating PBM practices.
• Mississippi's HB 1622 loosens certificate of need requirements for 55 rural hospitals through June 2027, allowing facilities to expand within five miles and open geriatric psychiatric units without state approval.
• The 4th Circuit blocked West Virginia's SB 325, which aimed to prevent 340B drug access restrictions, ruling it conflicts with federal law—a decision that contrasts with earlier rulings in Louisiana and Arkansas.
• A federal judge paused a Louisiana case challenging telehealth mifepristone dispensing while the FDA completes its safety review, stating the agency has the expertise to evaluate the drug's safety rather than the courts.

---

Supreme Court Ruling on Therapist Licensing and First Amendment Rights

The United States Supreme Court ruled 8-1 that the First Amendment prohibits states from using their licensing power to limit the topics therapists and other professionals can discuss with their clients. The case, Chiles v. Salazar, covered Colorado’s 2019 law that prohibits licensed counselors from engaging in conversion therapy with minors. Justice Neil Gorsuch wrote the majority opinion, in which the justices held that the 10th Circuit should have applied strict scrutiny, a more stringent standard of review, when determining whether Colorado’s ban violates the First Amendment. Thus, the court reversed the 10th Circuit’s ruling upholding the ban and remanded it to the appeals court for reconsideration under the stricter standard.

State Legislative Actions on Healthcare Policy

Kansas Pharmacy Benefit Manager Regulations Await Governor Approval

The Kansas House (104-17) and Senate (32-8) enrolled an amended version of SB 20, which now includes regulations on Pharmacy Benefit Managers (PBMs) adopted through a conference committee meeting in late March. As enrolled, the SB 20 would require PBMs to pay pharmacists a $10.50 dispensing fee and to disclose the rebates they receive and how they are paid out. Arkansas and West Virginia have enacted similar measures imposing dispensing fees on PBMs in recent years. The bill is now at Governor Laura Kelly’s (D) desk, who must take action by April 15th.

Mississippi Rural Hospital Certificate of Need Reform

Mississippi Governor Tate Reeves (R) signed HB 1622 into law, creating a pilot program benefiting 55 rural hospitals across the state that face loosened certificate-of-need (CON) requirements. Now, hospitals in small communities may open a new facility within five miles of their main campuses or make a nonclinical or clinical improvement above CON-defined thresholds. Notably, facilities located above the Mississippi Delta face even looser CON requirements and will be allowed two exemptions. The bill also allows facilities to open geriatric psychiatric units without seeking approval and requires parties who appeal the state’s approval of a new facility or improvement to pay the applicant’s legal fees if the ruling is affirmed. The program will continue through June 2027.

Federal Court Decisions on Drug Access and Telehealth

Louisiana Mifepristone Telehealth Case on Hold

A federal judge issued a stay on a case challenging the legality of telehealth dispensing for mifepristone. In doing so, he granted the Food and Drug Administration’s (FDA’s) request to place a hold on the case while it completes a safety review of the drug. The lawsuit challenges a 2023 FDA change that removed in-person dispensing requirements and allowed mifepristone to be prescribed via telehealth and delivered by mail order. In his ruling, the judge stated that the FDA, and not the District Court, had the expertise to evaluate the scientific evidence around the drug’s safety and make subsequent public health judgments.

West Virginia 340B Drug Access Law Blocked by Appeals Court

The 4th U.S. Circuit Court of Appeals upheld a preliminary injunction issued by the District Court for West Virginia to block the enforcement of SB 325. The law prohibited drug manufacturers from restricting any 340B-authorized location’s access to 340B drugs or requiring claims data as a condition for delivery. The Circuit Court held that SB 325 is preempted by federal law because it rewrites the “bargain” that Congress made with manufacturers and interferes with the Department of Health and Human Services' enforcement role. This decision contrasts with earlier rulings by the 5th and 8th Circuits, which upheld laws in Louisiana and Arkansas, respectively.

Track Health Care Policy

The ever-evolving state health policy landscape will continue to influence how health care organizations make business decisions. MultiState’s team pulls from decades of expertise to help you effectively navigate and engage. MultiState’s team understands the issues, knows the key players and organizations, and we harness that expertise to help our clients effectively navigate and engage on their policy priorities. We offer customized strategic solutions to help you develop and execute a proactive multistate agenda focused on your company’s goals. Learn more about our Health Care Policy Practice.