Weekly StateVitals Update: Volume 21 (May 27, 2025)
Colorado
State Employee Health Plan Reverses Course and Will Continue to Cover GLP-1s. Following an announcement earlier in the year of their intent to stop providing coverage for GLP-1s, the Colorado state employee health plan has opted to instead retain coverage for such drugs. The only caveat is that enrollees’ copays for such coverage will increase from $30 to $120 and the state will not cover new GLP-1 prescriptions for weight loss beginning in July. This will limit coverage only to those with an existing prescription prior to July 1. GLP-1 coverage for diabetes treatment will be exempt from the policy shift. The decision by the state employee health plan to retain such coverage follows the Legislature passing SB 48, which requires all large-group health insurance plans to offer consumers a plan that covers GLP-1s. That bill is still awaiting final action by the Governor.
Connecticut
Tentative Agreement Reached to Increase Medicaid Spending. For the first time in two decades, Connecticut lawmakers will exceed the state’s authorized spending cap to resolve a Medicaid shortfall expected at $300 million for the current fiscal year. In doing so, it would allow lawmakers to spend additional funds above the cap then what they would have been limited to in the next biennial budget, paving the way potentially for increased Medicaid reimbursement rates. The intent by the Legislature is to avoid having to delay payments to providers for an estimated six to seven weeks, which otherwise would have likely been the case without the increased funding beyond the state-mandated cap.
Senate Passes Bill Authorizing Limitations to Insurers’ Rate Increases. Last week, the Senate passed SB 10 by a 31 to 5 margin in the Senate. Among a number of provisions, the bill authorizes the Insurance Commissioner to establish rate increase limitations for insurers that have a continued history of increasing costs, and penalizing insurers that don’t comply with mental health parity federal and state requirements. Specifically, if the insurer’s rate increases exceed the state’s cost growth benchmark for the prior two years then the Insurance Commissioners can reduce the insurer’s proposed rate increase by up to two percent. Notably, the bill also establishes limitations on insurers from imposing certain prior authorization or utilization requirements on a provider’s use of anesthesia for patient services. The bill now goes over to the House for consideration.
Delaware
Governor Signs Bill Legalizing Assisted Suicide. This past week, first-term Governor Matt Meyer (D) signed HB 140 into law that legalizes physician-assisted suicide for a limited group of terminally ill patients. As enacted, the bill authorizes a terminally ill individual to request and self-administer medication to end the individual’s life if both the individual’s attending physician or advanced practice registered nurse (APRN) and a consulting physician or APRN agree on the individual’s diagnosis and prognosis. All parties must also believe the individual has decision-making capacity, is making an informed decision, and is acting voluntarily. A number of safeguards are written into the now enacted law, inclusive of patients having to adhere to two waiting periods before being prescribed certain medication, mental health diagnoses or illnesses are not a qualifying diagnosis for such a decision, eligible individuals must be evaluated by a psychiatrist or a psychologist in certain circumstances, and it does not require a private healthcare institution to allow the prescription or dispensing of certain medications for this bill’s purpose on hospital grounds, among others. The law will take effect when rules have been promulgated or by January 1, 2026.
Maryland
Governor Signs PDAB Bill into Law. Governor Wes Moore (D) signed HB 424 into law this past week. The measure will grant the state’s prescription drug affordability board with authority to limit what commercial health plans pay for certain drugs. Sponsored by Delegate Bonnie Cullison (D-Montgomery) builds on the 2019 law that set up the Maryland Prescription Drug Affordability Board by expanding the caps for state-run health plans to also apply to any health payer in the state. The law will go into effect on October 1, 2025 and will have Maryland join Colorado, Minnesota, and Washington with the ability to set upper payment limits on prescription drugs. The bill also amends the makeup of the Stakeholder Council that must be consulted prior to the establishment of UPLs.
Department of Health Proposes New Regulations for Community-Based Behavioral Health Programs. The Department of Health issued a new public comment period on proposed regulations for community-based behavioral health programs this past week. The regulations are intended to combat fraud, waste and abuse in the behavioral health system in the state. Specifically, the proposed regulations would establish licensing requirements for organizations rendering community-based behavioral health services in the state, establishes general staffing requirements that requires supervision of staff providing direct care to patients, and authorize the Behavioral Health Administration to have greater oversight of licensees to ensure compliance with new licensure and operating standards. The public comment period remains open through June 16.
Minnesota
Governor Reaches Budget Agreement to Eliminate Coverage for Undocumented Immigrants. This past week, Governor Tim Walz (D) and House and Senate leadership agreed to a budget deal that would make adult undocumented immigrants ineligible for healthcare coverage under MinnesotaCare. A goal of House Republican leadership, the agreement will leave children still eligible for the program. It’s estimated that more than 20,000 undocumented immigrants are currently enrolled in the program, with more than 76 percent of enrollees being above the age of 18. The Legislature adjourned on Monday of last week but is expected to have a long to-do list for an upcoming special session. It’s expected that the health and human services budget, which includes this provision of note, will be considered during the one-day special session the Governor is expected to call. At this point, many in the DFL party have indicated their intent to vote against the health and human services budget as currently proposed.
Montana
Governor Vetoes Medicaid Presumptive Eligibility & Mandatory Coverage Bills. This past week, Governor Greg Gianforte (R) opted to veto SB 72 and SB 244. SB 72 would have authorized for presumptive eligibility of Medicaid for home and community-based services, if the presumptive eligibility determination is made for services under the Big Sky Waiver Program or the Community First Choice Program which are utilized to prevent institutionalization or transition a patient from a hospital or other institutional setting. In his veto letter, the Governor iterated that SB 72 lacked appropriate safeguards to ensure that taxpayer-funded benefits were not provided to individuals that did not qualify. Related to SB 244, this bill would have required insurers to provide coverage for optional behavioral health screenings and assessments. The bill would have also been applicable to the state employee group benefit plan. In his veto message, the Governor iterated that uncovered mandates ultimately increase healthcare costs and would create additional taxpayer funded responsibilities that the Legislature did not appropriate funding for to offset the expense.
New York
Senate Passes Healthcare Package Targeting Prescription Drugs, Access and Health Equity. This past week, the New York Senate passed a package of bills that intend to reduce the cost of prescription drugs, expand healthcare access for consumers, and promote health equity for patients. The package comes as a response to the activity by Congress on the budget reconciliation process with expected implications for states that some stakeholders contend will reduce access to care and increase healthcare costs. As part of the package, the following bills were included:
S. 1618: The New York State Affordable Drug Manufacturing Act would authorize the Department of Health to establish partnerships with drug manufacturers to lower the cost of prescription drugs by enhancing access to more generic alternatives.
S. 355A: This bill authorizes individuals who have comparable coverage to a Medicare Part D plan to be eligible for the state’s Elderly Pharmaceutical Insurance Coverage program if they would otherwise qualify.
S. 1226: This bill requires general hospitals seeking to close entirely or to close a unit that provides maternity, mental health or substance use care to provide public notice and engagement opportunities.
S. 4950: This bill requires the Office of Addiction Services and Supports (OASAS) to establish a fee scheduled for services rendered OASAS treatment centers and prohibits those centers from denying treatment on the rationale that a person cannot pay.
S. 3202: Requires drug manufacturers to report all pay-for-delay agreements to the Attorney General’s office and the Attorney General’s office would then report to other state and outside entities the data in a searchable database.
S. 5812: Prohibits health plans from mandating providers that accept the Child Health Plus coverage plan that they offer to also accept all other insurance products offered by that same plan in order to participate in the plan’s network.
S. 371: This bill establishes a wholesale prescription drug importation program for the state, working with countries with consumer safety on part with the U.S. drug supply chain system and where consumer cost savings are possible.
The package of bills is now over in the Assembly for consideration.
New York Submits 1115 Demonstration Amendment. This past week, the Centers for Medicare & Medicaid Services (CMS) announced that the public comment period for an 1115 demonstration amendment for New York had opened. The state is requesting to modify its existing 1115 demonstration by implementing a new Medicaid Buy-In program for Working People with Disabilities. The state is intending to expand access to the MBI-WPD demonstration program by increasing income and resource levels authorized for eligibility, implement a new premium structure for cost sharing, cap program enrollment at 30,000 participants and eliminate the upper age limit of 62 years of age, among other amendments. The public comment period for the demonstration amendment is open through June 19, 2025.
Ohio
House Majority Floor Leader Introduces 340B Bill. This past week, House Majority Floor Leader Marilyn John (R-Richland County) introduced HB 276. The bill would establish a prohibition on manufacturers of dangerous drugs, repackager of dangerous drugs, or third-party logistics providers from denying, prohibiting or discriminating against 340B entities in a way that would limit the 340B entities’ ability to acquire a 340B eligible drug. The bill also would prohibit those same parties from requiring a 340B entity to submit any claims or utilization data as a condition for acquiring the 340B eligible drugs. As part of the bill language, the definition of 340B covered entity (or “grantee”) is limited in nature to exclude certain hospitals from the bill’s protection. As part of the Leader’s press release on the bill introduction, it was noted that federally qualified health centers are the main stakeholder behind the effort.
Oklahoma
Governor Vetoes 340B Reform Bill. This past week, Governor Kevin Stitt (R) opted to veto HB 2048. The bill would have prohibited pharmacy benefits managers (PBMs), insurers, third-party payors or its agent from reimbursing a 340B covered entity for 340B drugs at a rate lower than what is paid to entities that are not 340B covered entities. Additionally, the measure prohibited the imposition of any terms or conditions on 340B covered entities that would be dissimilar to non-340B entities, inclusive of fees and other charges, dispensing fees, participation in networks, and other limitations. The bill further prohibited discriminating against a 340B covered entity in any manner that might prevent or interfere with a patient’s choice to receive drugs from that 340B covered entity and additional restrictions tied to an entity’s 340B status.
A second part of the measure prohibits pharmaceutical manufacturers from limiting the acquisition of a 340B drug by a 340B covered entity or a contract pharmacy. However, the bill requires a 340B covered entity to contract with any willing pharmacy upon mutually agreeable terms if that pharmacy is within a fifteen-mile radius of the 340B covered entity’s location. As part of his veto message, Governor Stitt emphasized that while 340B is in deep need of reform, it should be done at the federal level. Whether or not the Legislature will override the veto is unknown.
Texas
House Passes Bill Clarifying Medical Exceptions to Abortion. This past week, the Texas House adopted SB 31 without amendments by a vote of 134 to 4. The bill specifies that physicians are allowed to perform an abortion if a patient is experiencing a life-threatening condition that may cause death. With support from advocates to ensure this clarity was provided to physicians, Democrats opted to join their Republican colleagues in support of the bill. This came after nearly two years of reporting about physicians who were confused about how to practice and provide abortion care with the current ban in place. The bill will now head to the Governor’s desk.
