Attorneys general are expanding their influence over health policy through opioid settlements, PBM reform, and Medicaid oversight. The Purdue/Sackler settlement yielded $7.4 billion effective May 1. Bipartisan coalitions of 39 and 45 attorneys general advocated for PBM reforms. Republican attorneys general challenged FDA mifepristone regulations, with Louisiana's litigation prompting Fifth Circuit action. Texas and Florida launched Medicaid fraud investigations and task forces.

The U.S. Supreme Court will decide by May 14, 2026, whether to reinstate mifepristone's in-person dispensing requirement nationwide, potentially reversing the FDA's 2023 change allowing telehealth prescriptions and mail distribution. Louisiana's lawsuit challenges this change, with courts finding the state likely has standing. Republican attorneys general from multiple states have filed cases targeting the FDA and out-of-state abortion medication providers, intensifying conflicts with Democratic states' shield laws.

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.

Texas and Louisiana pursued legal action against out-of-state abortion providers while enacting laws allowing private citizens to sue those providing abortion medication. Six blue states responded with protective measures allowing facilities rather than individual clinicians on prescription labels. Emergency abortion clarifications passed in Arkansas, Kentucky, Tennessee, and Texas, while Colorado, New York, Washington, Massachusetts, and Connecticut codified federal emergency care protections into state law.

Twenty-five states now require insurance coverage for fertility care as federal officials create new employer benefit pathways and negotiate lower drug prices. California delayed implementation of comprehensive IVF coverage mandates until 2026, while Virginia's commission drafted legislation requiring three IVF cycles in benchmark plans. Arkansas became the first state enacting restorative reproductive medicine legislation, though Nevada's governor vetoed broader Medicaid fertility coverage citing fiscal concerns.

State legislatures remain deeply divided on reproductive health policy in 2025. Following 2024 ballot measure victories for abortion protections in seven states, Republican lawmakers in Montana and Missouri are pushing counter-measures. States are clarifying emergency abortion exceptions amid legal challenges, while blue states codify EMTALA protections. Medication abortion faces ongoing restrictions in red states and protective measures in blue states.