Weekly StateVitals Update: Volume 32 (August 11, 2025)

National

• Attorneys General Sue to Protect Access to Gender Affirming Care. This past week, a group of 12 Attorneys General filed a lawsuit that claims the Trump Administration and its Justice Department are taking unconstitutional steps to mitigate the provision of gender affirming care across state lines. Much of the direction that the Trump Administration has been provided via executive orders on limiting states’ ability to allow gender affirming care and resulting implementation; it’s argued that such actions aren’t based in law. Rather, the executive orders and resulting implementation are merely  tactics to suppress access to healthcare. The states of California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, Nevada, Pennsylvania, Rhode Island and Wisconsin are all named as plaintiffs in the lawsuit.

• SNAP Waivers Approved by USDA. Earlier this past week, the U.S. Department of Agriculture approved Supplemental Nutrition Assistance Program (SNAP) waivers submitted by Colorado, Florida, Louisiana, Oklahoma and Texas. Specifically, the waivers would limit SNAP recipients from leveraging such funds to purchase soda and other sugary beverages. The approval period for Colorado is for two years and initiates on March 1, 2026. In Louisiana the limitation begins on January 15, 2026 and in Florida, it begins on January 1, 2026. Notably, in Florida and Louisiana, both waivers also prohibit use of SNAP funds on candy products. The prohibition specifically applies to nonalcoholic beverages that contain natural or artificial sweeteners but does not include milk, soy, rice or similar milk substitutes or beverages with greater than 50 percent of vegetable or fruit juice by volume. The six states now join six others in having been approved with similar waivers.

Alabama

• CON Reform to be Considered in 2026. This past week, Senator Larry Stutts indicated his intent to once again file legislation in 2026 that would reform the certificate of need (CON) process in Alabama. In recent years, Senator Stutts and other colleagues have introduced legislation to either fully repeal CON in the state or to repeal it for certain circumstances, the latest in 2025 being to exempt psychiatric and obstetric services from the CON process. Notably, Senator Stutts continues to highlight the administrative burden of the CON process in Alabama and while he’s not entirely sure what his latest iteration will look like it’s likely to reflect recent efforts that take a narrow and targeted approach to the CON process. 

Arizona

• Governor Issues EO on Drug Discount Cards. This past week, Governor Katie Hobbs (D) issued a new executive order that authorizes Arizona to join other states as part of the ArrayRx discount drug program. Joining Oregon, Washington, Nevada, Ohio and Connecticut, the program is free to any resident and can allow residents who use their ArrayRx discount cards to save up to 80 percent on some prescription drug costs out-of-pocket. It’s expected that residents can begin enrolling in the discount program beginning in early 2026. It’s unclear how many residents will participate in the program but is likely a response to the Governor’s inability to generate interest in legislative measures that would have capped prescription drug costs in the state through establishment of a prescription drug affordability board and providing such a board with upper payment limit setting authority. 

Arkansas

• Governor Calls on Insurance Department to Disapprove of Insurers’ Rate Increases. Governor Sarah Huckabee Sanders (R) has called on the Insurance Commissioner to reject some insurers’ rate filings for the upcoming plan year on the state’s Exchange. The Governor contends some filings, ranging between 25.5 and 54 percent increases on individual premiums, are excessive in nature. Largely, insurers have noted that such rate increases are similar in nature to what’s happening across the industry as a result of increases in the cost of hospitalizations, outpatient surgeries, prescription drugs and increased utilization. Additionally, the uncertainty as to the continuance of the enhanced Advance Premium Tax Credits and other federal and state policy pressures have impacted how insurers are able to obtain actuarially sound rates. At this time, the Insurance Commissioner has yet to issue a decision on the rate filings. 

Illinois

• Governor Signs AI Therapy Prohibition Bill into Law. Governor JB Pritzker (D) signed HB 1806 into law this past week. The Wellness and Oversight for Psychological Resources Act prohibits anyone from using artificial intelligence (AI) to provide mental health or therapeutic decision-making. The intent is to prohibit certain AI products from being marketed to consumers, while at the same time limiting opportunities for qualified behavioral health providers. Violations of the Act will carry penalties of up to $10,000 per occurrence and enforcement will be overseen by the Illinois Department of Finance and Professional Regulation. The Act has an immediate effective date.

Massachusetts

• Governor Signs Updates to Shield Law. Governor Maura Healey (D) signed into law S. 2538, which provides an update to the state’s Shield Law in establishing additional protections for physicians providing abortion and gender affirming care. Notably, the newly enacted law prevents the disclosure of sensitive data, such as a physician’s name, and establishes that abortions must be provided in emergencies if medically necessary. The bill also prohibits state and local authorities from cooperating with federal or other state investigations into services that are legally protected in Massachusetts. The new law will also require the Department of Public Health to establish a technical advisory group that provides support to businesses on implementing privacy protections for storing or managing electronic medical records as they pertain to abortion and gender-affirming care. Finally, of note, the law prohibits insurance companies from discriminating against or penalizing providers offering reproductive or gender affirming care services. The bill came in response to some states and the federal government seeking to bring lawsuits or freeze federal funding for certain care providers in recent months. 

Montana

• Lawsuit Filed to Declare Right to Abortion Constitutional Initiative Invalid. This past week, the Montana Life Defense Fund and the Montana Family Foundation filed suit in Yellowstone District Court requesting that Constitutional Initiative 128 be held invalid. Notably, their lawsuit contends that the full text of the ballot initiative was not printed on the ballot. Under such logic, every constitutional  amendment passed since 1978 would thus be invalid. However, the two entities are only challenging this constitutional initiative due to a two-year statute of limitations. The Montana Supreme Court has previously criticized and voted against this position but the two entities have vowed to continue building their case through the courts. 

New Hampshire

• Governor Signs Bill Prohibiting Surprise Billing for Ground Ambulance Services. Recently, Governor Kelly Ayotte (R) signed SB 245 into law. The measure sets a reimbursement rate of 325 percent of Medicare in cases of out-of-network services being delivered for the first two years of the bill’s implementation. After those two years are up, the Insurance Department will then set a new and updated rate based on an actuarial study that accounts for inflation and other influencing market factors. During the past session, there were a number of competing bills to address surprise billing for ground ambulance providers. Ultimately, the ambulance stakeholders aligned on this measure given the comparatively higher reimbursement rate compared to other proposals. New Hampshire becomes the 17th state to implement such legislation. 

North Carolina

• Hospital Certificate of Need Litigation Continues.  This past week, the North Carolina Supreme Court issued an order without comment that granted a hospital system’s request for a temporary stay of a lower court’s decision granting the addition of 67 acute care beds to a competing health system, AdventHealth. The stay likely represents the Court’s interest in a case in which Mission Memorial argues AdventHealth should not be allowed to build a 222 bed hospital in the state after being granted approval for necessary beds via the certificate of need process nearly three years ago. Mission had alleged as part of the litigation that the state failed to allow certain attendees to speak at a public hearing determining approval status of the certificate of need. Both Mission and Novant Health had also applied for a certificate of need at the time for the additional 67 beds. There is no timeline that the Supreme Court is required to return a decision by. 

  This latest development follows an interest by the Court in examining certificate of need laws in the state. Back in October 2024, the North Carolina Supreme Court issued a unanimous ruling requiring a lower court to undertake a broad trial to determine whether certificate of need laws in the state are unconstitutional. At issue is an ophthalmologist’s complaint that he could perform a certain cataract surgery for $1,800 while the local hospital charges $6,000 for the same procedure. However, the ophthalmologist contends he is prohibited from purchasing the equipment necessary to perform the procedure because certificate of need rulings have been issued iterating that only the hospital may perform such a procedure in the defined geographic area. The Supreme Court noted in its instructions back to the lower court that, “the complaint contains allegations that, if proven, could render the Certificate of Need law unconstitutional in all its applications.”

Oklahoma

• Governor Blocks Public Funding to Abortion Providers. This week, Governor Kevin Stitt (R) via executive order directed the Oklahoma Health Care Authority to terminate and not renew any Medicaid contracts to physicians or entities that are affiliated with the performance of abortions that are not permitted under state law. The Governor argues that a June U.S. Supreme Court decision affirms the rights of states to determine which providers are eligible to enroll in the state’s Medicaid program. The state currently has no licensed abortion providers. The executive order also calls on the Authority to initiate a plan for enforcement and compliance of this directive and implement revised standards within 120 days. 

Oregon

• Governor Signs Behavioral Health Reform into Law. This past week, Governor Tina Kotek (D) signed a multitude of bills into law that are packaged as a reform effort to address the state’s behavioral health crisis. The bills highlight an interest in reforming the structure of behavioral health delivery in the youth, with a focus on those with severe mental illness and youth. Specifically, the following bills were signed into law: 

  • HB 2059: Establishes the Residential Behavioral Health Capacity Program which appropriates and authorizes funds ($65.7 million) to be distributed to behavioral health providers with capacity shortfalls. 

  • HB 2024: Requires the Oregon Health Authority to establish a statewide grant program to recruit and retain workforce in the behavioral health space. 

  • HB 2005: Broadens the standards for what may constitute for civil commitment and authorizes the judicial branch to consider past or future behavior in a civil commitment hearing as they assess whether such commitment is necessary. 

  • HB 3321: Requires the Alcohol and Drug Policy Commission to create a statewide strategy for youth substance use prevention.