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.

President Trump signed the One Big Beautiful Bill Act on July 4, 2025, cutting federal Medicaid spending by $1.02 trillion over ten years. The legislation imposes work requirements, freezes provider tax rates, caps state-directed payments, and requires six-month eligibility redeterminations for expansion states. Most significant budget impacts won't hit states until 2028.

States incorporated significant healthcare reforms into budget bills as sessions concluded and the new fiscal year began July 1st. California's $321 billion budget freezes Medicaid enrollment for undocumented adults starting 2026, while Minnesota eliminated coverage for approximately 15,000 undocumented adults. Florida boosted Medicaid rates for long-term care facilities by $286 million, Ohio established automatic Medicaid expansion termination if federal match drops below 90%, and Wisconsin raised hospital provider taxes to generate $1.5 billion in additional Medicaid funding.

As states and the federal government look for ways to cut spending, an obvious place to look is one of the largest budget items for all jurisdictions: Medicaid. The addition of work requirements for recipients has been a perennial (though so far unsuccessful), option for budget conscious legislators. So far in 2025, 12 bills in 7 states have been introduced that would require some community engagement in order to receive Medicaid benefits.