Weekly StateVitals Update: Volume 37 (September 15, 2025)

* Recognizing the increasing activity on state COVID-19 vaccine guidance, MultiState is in the process of developing a COVID-19 state vaccine guidance tracker. We expect this to be published to StateVitals in the coming days and a link will be included in the Weekly StateVitals Update published on September 22. 

National

• HHS Releases MAHA Report on Childhood Chronic Disease. This past week, the U.S. Department of Health and Human Services (HHS) released the Administration’s Make Our Children Healthy Again Initiative. HHS Secretary Robert F. Kennedy, Jr. stated when presenting the plan that the intent was to provide a slate of initiatives of which he believes can be achieved before the end of the year. The report identified poor diet, chemical exposure, a lack of physical activity and chronic stress, and overmedicalization as the driving factors of rising childhood chronic disease. Although there are little legislative or regulatory interventions that are specifically included in the strategy, there is some nexus with state-level policy lanes that stakeholders should be aware of. Notably, the report iterates that the Administration will take the following steps:

  • The Centers for Medicare & Medicaid Services (CMS) will collaborate with states to establish new quality metrics for Medicaid managed care organizations to promote measurable health improvements via nutrition coaching and other fitness indicators.

  • CMS will collaborate with states to enhance prior authorization requirements and establish prescribing safeguards to address the overuse of medications in school-age children, particularly as it relates to conditions like ADHD. 

  • CMS will collaborate with states to promote evidence-based prevention and wellness initiatives for CHIP enrollees.

  • The U.S. Department of Agriculture will provide states with technical assistance in SNAP waiver development and implementation to restrict the purchase of junk food and reorient the program towards better nutrition. 

  • HHS and the Department of Education will work with states and school districts to re-establish the Presidential Fitness Test. 

  As it relates to Medicaid quality metrics or increasing the use of prior authorization for medication for children, particularly as it relates to CHIP and Medicaid, it remains unclear what that process will look like for states to implement. 

• CMS Issues Guidance to States on Oversight of State Directed Payment Programs. The Centers for Medicare & Medicaid Services (CMS) this week issued its preliminary guidance for state Medicaid programs pertaining to how they intend to implement and provide oversight of the new federal limits for state directed payment (SDPs). The guidance offers some clarity as it relates to how CMS will handle the grandfathering process for pending SDPs submitted prior to July 4, 2025. The key elements of the guidance are:

  • Beginning with rating periods on or after July 4, 2025, SDPs for inpatient and outpatient hospital services, nursing facility services and qualified practitioner services at an academic medical center may not exceed 100 percent of Medicare rates in expansion states or 110 percent of Medicare in non-expansion states. 

  • If an eligible SDP was submitted for review and approval or was approved prior to July 4, 2025, the SDP may qualify for temporary grandfathering until rating periods begin January 1, 2028, followed by the phased reduction as outlined in the statute. 

• For SDPs currently under review by CMS, CMS will notify states of whether the SDP qualifies for grandfathering in approval letters for the SDP.

• For any SDP preprints that do not qualify for grandfathering, states must revise those pending or any future preprints so as to comply with the new federal law. 

California

• Legislature Enrolls Significant Healthcare Bills Before End of Session. The Legislature opted to enroll a number of significant healthcare pieces of legislation prior to the end of session last week. Among those bills include: 

  • Prior Authorization: Enrolled were SB 306 and AB 682, both of which seek to enhance transparency for consumers and healthcare stakeholders by implementing reporting requirements on health plans with regard to prior authorization data, including denials. Additionally, SB 306 establishes a gold-carding like program by requiring the state to identify the health care services approved at a rate of at least 90 percent and would require a plan or insurer to cease requiring prior authorization requirements for such covered health care services by a date determined by the department, which will be no later than January 1, 2028. 

    Additionally, AB 512 was enrolled which shortens the timeline for prior authorization determinations related to non-imminent or non-serious threats to a patient’s health to 3 business days from the plan’s or insurer’s receipt via electronic submission, or 5 business days from receipt via submission that is not electronic. However, for prior authorization requests relative to imminent or serious threats to a patient’s health, the bill requires a decision to be made within 24 hours from receipt electronically, or 48 hours from receipt via submission that is not electronic. 

  • PBM Reform: SB 41 was enrolled and sent to the Governor’s desk. The bill would prohibit a PBM from requiring the use of an affiliated pharmacy by an enrollee and from discriminating against a non-affiliated pharmacy. Additionally, the measure limits a PBM’s income to that derived from a fee for PBM services, and also requires that PBMs utilize a pass-through pricing model.

  • Abortion & Gender Affirming Care Protections: The Legislature enrolled AB 82 and AB 260. AB 82 expands a state address confidentiality program to providers rendering gender-affirming care and prohibits any entity or individual from soliciting, selling or trading personal information or the image of a provider rendering gender affirming care. Further, the bill would prohibit a prescription for the dispensing of testosterone or mifepristone from being reported to the state or a state contractor and expand the definition of legally protected healthcare, among other provisions. AB 260 would authorize pharmacists to dispense mifepristone and other medications for abortion care without the name of the patient, prescriber or the pharmacy on the prescription tag, among other provisions.

  The enrolled bills now go to the Governor for his consideration. For bills enrolled in this final week of session, the Governor has 30 days to either take action the bills or allow them to become law without his signature.

Connecticut

• Governor Issues Executive Orders to Expand Access to COVID-19 Vaccines. Governor Ned Lamont issued a number of executive orders this past week with the intent to sustain access to the COVID-19 vaccine for non-prioritized populations as described under new federal guidance. The Administration is encouraging children and adults aged six months or older to be vaccinated. The Department of Consumer Protection in the state has issued guidance to pharmacists that authorizes them to administer a COVID-19 vaccine to individuals outside of the federal eligibility criteria to adults 18 years or older without a prescription. 

Minnesota

• Governor Issues Executive Order Promoting Access to COVID-19 Vaccines. Responding to recent federal guidance on COVID-19 vaccine administration, Governor Tim Walz (D) issued a new executive order that intends to sustain access for all residents to the COVID-19 vaccine. Specifically, the executive order directs the state epidemiologist to issue a standing order for the vaccine, which provides greater flexibility for providers and pharmacists to administer the vaccine regardless of the federal guidance. According to the order, licensed pharmacists can administer COVID-19 vaccines to patients that are age three and older without a separate or distinguished prescription specific to COVID-19. The standing order is to be provided by September 24. Finally, the Department of Health and Department of Commerce are required to convene payors, providers and other professional organizations in the state to identify barriers to vaccine access and ways to address those barriers by October 6. 

Mississippi

• U.S. Court of Appeals Denies Request for Preliminary Injunction Against Enforcement of 340B Law. This past week, the United State Court of Appeals for the Fifth Circuit affirmed a district court’s decision to deny a drug manufacturer’s request for a preliminary injunction against implementation and enforcement of a 340B reform law passed by the Mississippi Legislature in 2024. The bill prohibits drug manufacturers from denying, restricting, prohibiting or interfering with a 340B covered entity or its contract pharmacy the acquisition of a 340B drug. Similar to the findings of the district court, the Appeals court found that the manufacturer had not met its burden of showing a substantial likelihood of success on its taking claim before the court, nor its field or conflict preemption arguments. 

Nebraska

• State Opts to pivot and Fund Statewide Drug Disposal Program. After announcing earlier this year that the state intended not to fund the state’s statewide drug disposal program moving forward at an annual cost of $289,416, the state opted to reverse course this past week. Originally, the Legislature had appropriated the requisite funds to continue the existing contract for the vendor operating the program but the Department of Health and Human Services had opted to not yet renew the contract and effectively froze the funds appropriated. This week, the Department announced that they would extend the contract through June 30, 2026. Effectively kicking the can for the 2026 legislative session where lawmakers will decide its appropriation fate again for a two-year budget cycle. 

New Jersey

• Department of Health Issues Executive Order to Enhance Access to COVID-19 Vaccines. The Department of Health in New Jersey issued an executive directive this past week which authorizes anyone that is six months or older to receive the COVID-19 vaccine. The Department also issued a standing order authorizing pharmacists to administer the vaccine without a prescription to individuals that are age three or older, whereas those under the age of three are authorized to receive the vaccine from their health care provider. In the press release, the Governor and Department of Health encouraged all insurance carriers to continue covering the costs of the COVID-19 vaccine for all ages six months and older without cost-sharing requirements.

New York

• Governor Issues Executive Order Promoting Access to COVID-19 Vaccines. Similar to other states in recent weeks, Governor Kathy Hochul (D) issued a new executive order which will allow pharmacists to administer COVID-19 vaccines to anyone 3 years of age or older without a prescription. This population is inclusive of those who are pregnant, healthy adults and children aged 3 to 17 years. The order declares a 30-day statewide emergency to authorize this expansion of services as to who is eligible to prescribe and administer COVID vaccines and will need to be renewed every 30-days moving forward should the Governor opt to retain such flexibility.

• Department of Health Announces Intent to Terminate Section 1332 Waiver. This past week, the New York State Department of Health announced they are taking a number of steps to respond to the likely fiscal and administrative implications of the One Big Beautiful Bill Act. Notably, the state is terminating its Section 1332 State Innovation Waiver and Essential Plan expansion and reverting back to a Basic Health Program. This is  due to Section 71302 of the OBBA, which prohibits premium tax credits during any month of which a person is Medicaid-ineligible due to their immigration status. The State Innovation Waiver had originally been approved to expand the essential plan to residents who were not eligible for Medicaid with incomes up to 250% of the FPL. The provision in the federal bill would have meant a $7.5 billion reduction in annual funding for the state to provide such coverage and the state determined it was unable to pick up that cost with state-only funds. The state intends to terminate the waiver program by July 2026.

South Carolina

• Total Abortion Ban Bill Set for October Hearing. This past week, it was announced that the Senate Medical Affairs Committee will hold a hearing on SB 323 this October. The Unborn Child Protection Act seeks to prohibit all abortions in South Carolina by repealing language that pertains to the requirement of fetal heartbeat timeline in existing law. The current law allows an abortion if done before a steady cardiac activity is detected via ultrasound. The proposed bill would ban abortions regardless of the presence of  steady cardiac activity or not unless a physician decides that a medical emergency that risks the life of the mother necessitates an abortion. The hearing is scheduled for October 1 at 9:30 a.m. 

Virginia

• Department of Health Issues Order on COVID-19 Vaccines. This week, the Virginia Department of Health issued a standing order that will allow state residents 18 and older to receive the COVID-19 vaccine without a prescription. Similar to activity in other states, this comes in response to recent federal guidance that limits which populations are recommended to receive the vaccine. The order authorizes pharmacists and pharmacy interns that have satisfied certain training requirements and under the supervision of a pharmacist to dispense and administer the vaccine.