No state Medicaid program provides broad IVF coverage, though New York, Utah, and Washington, D.C. offer limited fertility benefits. Utah implemented IVF coverage in 2024 for carriers of specific genetic diseases, while New York and D.C. cover three cycles of ovulation-enhancing drugs. Seven states require Medicaid fertility preservation coverage for iatrogenic infertility. Private insurance mandates have expanded significantly, with 15 states now requiring IVF coverage and 21 states mandating fertility preservation coverage.

State Medicaid programs face severe fiscal constraints, with at least 14 states experiencing shortfalls last fiscal year. During 2026 legislative sessions, states implemented cost-containment measures: Colorado capped enrollment at 25,000 for its immigrant coverage program; Idaho cut reimbursement rates by $21.8 million; Iowa addressed a $91 million shortfall through increased MCO taxes; North Carolina raised copayments and tightened eligibility; Oklahoma debates expansion authority while adding $250 million in funding.

Twenty-five states and Washington, D.C. currently require private insurance coverage for fertility care, while only New York, Utah, and D.C. offer limited Medicaid coverage. In 2026, Virginia enrolled legislation requiring coverage for three IVF cycles by 2028, while Arizona and Hawaii advanced bills mandating coverage for iatrogenic infertility. Connecticut expanded its infertility definition under existing mandates, reflecting states' focus on incremental coverage expansions.

Tennessee's HB 1959, prohibiting PBM pharmacy ownership, passed the House Insurance Committee 16-3 and advances to Government Operations Committee. House Speaker Cameron Sexton co-sponsored the bill citing anti-competitive concerns. Oklahoma's HB 3538 unanimously passed committee with similar restrictions but includes exceptions for rare and orphan drugs, awaiting full House vote. Similar legislation is pending in seven additional states.

Healthcare policy groups including FARB, NAIC, NAMD, NASHP, and NCOIL serve as platforms for state policymakers to collaborate and shape emerging trends. In 2025, multiple organizations adopted model legislation on facility fees and site-neutral payments, with NCOIL passing its Prior Authorization Reform Model Act in November. Groups are now focusing on the Rural Health Transformation Program and 340B oversight for 2026.

Following September 2025 federal restrictions limiting COVID-19 vaccine eligibility to adults 65+ and high-risk individuals, 18 states implemented protective measures including executive orders allowing pharmacy administration without prescriptions. Regional alliances like the West Coast Health Alliance and Northeast Public Health Collaborative emerged, while Florida moved to eliminate school vaccine mandates. The bipartisan Governor's Public Health Alliance launched October 15 with 15 governors coordinating responses.

Delaware legislators introduced SB 213 eliminating hospital budget oversight authority, while Florida faces court-ordered Medicaid termination pauses after constitutional violations. North Carolina's certificate of need laws face ongoing legal challenges, and New York Governor Hochul proposed $71 million in healthcare investments including mental health licensing reforms. Utah became the first state implementing AI prescription renewals for chronic conditions.

Over the past month, arguably no Governor and Legislature have been as proactive in healthcare reform as newly elected Indiana Gov. Mike Braun (R) and Indiana’s General Assembly. In late January, the Governor issued six executive orders pertaining to healthcare access, affordability and transparency.