States are advancing healthcare legislation across three key areas as legislative sessions conclude. Multiple states enacted insurance reforms targeting utilization management and prior authorization, with Iowa, Utah, South Dakota, Washington, and New Mexico leading efforts. Indiana, Wyoming, and Utah passed Medicaid eligibility verification measures responding to federal reforms. Several states expanded scope of practice for pharmacists and mid-level providers to qualify for Rural Health Transformation Program funding.

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.

Despite a December 2025 White House Executive Order threatening to cut BEAD Program funding for states with comprehensive AI oversight, nine states including Alabama, Hawaii, Indiana, Mississippi, Oklahoma, Rhode Island, Tennessee, Virginia, and Vermont have introduced 2026 legislation restricting insurers' use of AI in coverage decisions, with federal review expected by mid-March.

Fifteen governors launched a public health alliance to improve emergency preparedness and coordination across state lines, while CMS announced all 50 states applied for the $50 billion Rural Health Transformation Program. California enacted major healthcare transparency and PBM oversight legislation, Colorado proposed significant Medicaid spending cuts, and Massachusetts advanced prior authorization reforms.

The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act and advanced artificial intelligence oversight policies at its Atlanta annual meeting. The Health Insurance Committee addressed charity care screening requirements and medical debt protections, while the Financial Services Committee continued developing AI governance standards requiring human professionals to make claim denial decisions. Legislators discussed expiring ACA tax credits' impact on market stability with state insurance commissioners.

States pursued multiple approaches to reduce prior authorization barriers in 2025, with gold card programs leading reform efforts. Arkansas, Texas, and West Virginia amended existing gold card legislation, while Iowa's pilot program was removed. Indiana and Montana established 24-48 hour review timeframes and coverage continuity requirements. Maryland restricted AI use in determinations, requiring patient-specific data and human physician oversight for adverse decisions.

Virginia and Utah wrapped up their sessions with significant healthcare legislation. Both states enrolled legislation that stands to have significant influences to the state of healthcare delivery and coverage and public health.

In 2025, state lawmakers are expected to prioritize healthcare affordability and access, building on key legislative trends from this year. Here are our thoughts on key trends and issues from 2024 and how they might show up in state capitols next year.