Weekly StateVitals Update: Volume 34 (August 25, 2025)
National
CMS Announces Initiative to Disenroll Noncitizens from Medicaid. This past week, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative aimed at disenrolling noncitizens from Medicaid and the Children’s Health Insurance Program (CHIP). The effort is two fold:
CMS will begin providing each state Medicaid agency with a monthly enrollment report identifying enrollees whose citizenship or immigration status were unable to be confirmed through federal databases.
States will take those reports, review those cases that exist by verifying citizenship or immigration status, request additional documentation from those enrollees identified, and then make a determination to adjust coverage or enforce non-citizen eligibility rules.
States received their first report this week. This initiative follows one from July where CMS and the Department of Homeland Security had agreed that CMS would hand over enrollees’ personal information to Immigration and Customs Enforcement (ICE) for the purpose of identifying the location of undocumented immigrants in the United States. Notably, that initiative is stuck in federal court after an initial order was issued temporarily blocking the Administration from moving forward, finding that it stands to disrupt the operation of Medicaid.
California
State Marketplace Announces Average Increased Premium Rates of 10.3 Percent in 2026. California’s state marketplace, Covered California, recently announced that its participating health plans expect an average rate increase of 10.3 percent for consumer premiums in plan year 2026. Comparatively lower than what some other state-based marketplaces have announced, Covered California notes that the increase is attributed to a multitude of factors, inclusive of increased health care and pharmacy expenditures and federal health care policies. Notably, they iterate that this premium increase could be reduced if Congress reauthorizes the enhanced premium tax credits that have been in place for the past four years. They highlight that lack of reauthorization of the enhanced premium tax credits will result in an average net premium increase of 66 percent for 1.7 million enrollees on the state based marketplace.
Colorado
General Assembly Passes Bill Funding Medicaid for Reproductive Health Care. During a special session called by Governor Jared Polis (D), the Senate and House of Representatives this weekend passed SB 25B-2. The measure was a response to the enacted reconciliation bill passed by Congress this summer that barred federal Medicaid funds from being utilized to reimburse Planned Parenthood for non-abortion care related services. The bill requires the Department of Health Care Policy and Financing to use state funds to reimburse healthcare providers prohibited from receiving federal Medicaid funds. The bill is estimated to have a $4.4 million fiscal note for the current fiscal year tied to it. It’s expected to be signed into law by Governor Polis.
Florida
State Could be Looking at a Medicaid Shortfall in the New Fiscal Year. Based on recently released Medicaid expenditure projections, the Social Services Estimating Conference is estimating that the recently approved budget will fall $510.7 million short of what is needed to cover Medicaid costs. The report highlights that payments to Medicaid managed care organizations are likely to drive the shortfall. Despite the increase in Medicaid expenditures, the Conference also revised its estimate on the number of Medicaid enrollees over the new fiscal year since the budget was passed and assumes approximately 67,000 fewer people will be enrolled than previously estimated.
Georgia
Insurance Commissioner Leverages Penalties on Insurers for Mental Health Parity Violations. Recently, the Georgia Insurance Commissioner, John King, announced his intent to fine 22 insurance companies nearly $20 million for failure to comply with a 2022 state mental health parity law. Signed three years ago, Georgia’s Mental Health Parity Act was enacted with the intent to improve enforcement mechanisms in alignment with federal mental health parity laws. The Act specifically provides the Insurance Commissioner with authority to penalize insurers with fines for failure to comply with state regulations on mental health parity. Notably, as part of its first review since the law was enacted, the Insurance Commissioner’s office found 6,000 violations in which companies could be fined up to $2,000 per violation or $5,000 per violation if the insurer reasonably could have known or did know they violated existing law. The 2022 law also requires the Insurance Commissioner to conduct an in-depth review of insurer data and submit an annual report to the Speaker of the House, Governor and Lt. Governor every year of mental health parity compliance. The most recent report has yet to be published.
Idaho
Medicaid Providers to See 4 Percent Cut. The Department of Health and Welfare sent out notification to its enrolled Medicaid providers that they will be seeing a 4 percent reimbursement rate cut across the board for nearly all services effective September 1, 2025. The announcement came shortly after Governor Brad Little (R) had issued a directive to all state agencies that funding for most all programs and agencies, not including K-12 education funding, was required to be cut by at least 3 percent. Notably, the Joint Finance-Appropriations Committee found that the Medicaid budget growth for the next fiscal year is expected to be 19 percent, approximately 11 percent higher than what was initially expected. As part of the cuts, and in alignment with the provider reimbursement rate cuts, managed care capitation rates and pharmacy benefit rates will also be cut by 4 percent. For pharmacy reimbursement claims, this includes a 4 percent reduction for claims being paid at the Wholesale Acquisition Cost, State Maximum Allowable Cost, or the federal Upper Limit and professional dispensing fees.
Iowa
Governor Confirms Medicaid Work Requirements Implementation Date. Despite the recent enactment of the One Big Beautiful Bill Act by Congress, Iowa Governor Kim Reynolds (R) has confirmed that the state intends to move forward with its own implementation of a submitted 1115 Medicaid waiver application to start work requirements for Medicaid expansion enrollees beginning January 1, 2026. Under the federal reconciliation package, work requirements were scheduled to begin in 2027. By following the waiver, which is expected to be approved by the Centers for Medicare & Medicaid Services (CMS), the most significant variation is a 100 hours per month requirement of work or community engagement activities instead of the federal mandated requirement of 80 hours. Governor Reynolds estimated that this will impact approximately 100,000 Medicaid expansion enrollees in the state when considering populations that would be exempt from the requirements.
Kentucky
Governor Makes Bromazolan a Schedule I Drug. Governor Andy Beshear (D) issued an emergency state designation of Bromazolan, commonly referred to as “Designer Xanax,” as a Schedule I controlled substance. In doing so, it prohibits the sale of Bromazolan in the state of Kentucky and ensures that law enforcement are authorized to make arrests for the sale or possession of the drug. The emergency designation came at the request of the state Attorney General following an increase in fatal overdoses as a result of using the drug in 2024 despite statewide trends that saw declines in all overdose deaths. While the drug remains unscheduled at the federal level, more than 20 Attorneys General signed onto a letter this week asking for the drug to be classified as a Schedule I drug at the federal level.
New Hampshire
Expansion to Right to Try Bill Signed Into Law. This past week, Governor Kelly Ayotte (R) signed HB 701 into law. The bill expands the underlying Right to Try Law in the state, which authorizes patients with terminal illnesses to undergo experimental treatments that have completed the first phase of clinical trials but have not yet been approved by the FDA. HB 701 limits the ability of patients applicable to the state’s right to try law to sue providers and manufacturers for malpractice or deleterious impacts. The intent is to incentivize manufacturers and providers to administer such treatments without fear of falling subject to a civil lawsuit. Also included in the bill is a provision to authorize providers to conduct remote prescreening and sign consent forms through telehealth.
New Mexico
Interim Committee Hears Research on Prior Authorization and Provider Burden. The New Mexico Legislative Health and Human Services Committee held an interim meeting last week over three days to discuss a variety of issues related to medication assisted treatment, juvenile justice reform, child welfare, opioid settlement funds, and the claims and billing process for providers. Notably on the last element, the interim committee heard from the University of New Mexico Center for Social Policy about their latest research publication pertaining to administrative burden in the claims and billing process, inclusive of prior authorization. The Center had produced a report on the issue at the request of the Legislative Council Service. The findings of the research included recommendations to lawmakers to find policy interventions to reduce administrative complexity for patient care and clinicians, inclusive of prior authorization relief. The report also highlighted how rural health facilities feel this administrative burden heavier than other institutions and encouraged lawmakers to examine remedies specifically for those facilities as part of any policy response.
