Weekly StateVitals Update: Volume 38 (September 22, 2025)
To better help StateVitals Subscribers understand the moving landscape as it relates to the availability of COVID-19 vaccines across states, MultiState has developed a COVID-19 Vaccine State Guidance Tracker. The tracker will be updated on a weekly basis and will include the latest executive orders, state guidance or standing orders as have been made publicly available.
National
CMS Releases Application Information on Rural Transformation Program. This past week, and as authorized under the One Big Beautiful Bill Act, the Centers for Medicare & Medicaid Services (CMS) has released additional details on how states can apply for a $50 billion grant program for rural healthcare facilities in their states. The $50 billion in grant funds will be allocated to states over five years, with $10 billion being available each year beginning in FY 2026. Notably, $25 billion will be awarded to states with an approved application and evenly distributed among those states. The other $25 billion will be awarded to approved states based on individual state metrics and applications that reflect the best potential to scale the impact on the health of rural communities and align with the program’s objectives. Notably, funding from the program will be awarded to programming that aligns with the following:
Make rural America healthy again: Support rural health innovations and new access points to promote preventative health and address root causes of diseases.
Sustainable access: Help rural providers become long-term access points for care by improving efficiency and sustainability.
Workforce development: Attract and retain a highly skilled health care workforce by strengthening recruitment and retention of health care providers in rural communities.
Innovative care: Spark the growth of innovative care models to improve health outcomes, coordinate care, and promote flexible care arrangements.
Tech innovation: Foster use of innovative technologies that promote efficient care delivery, data security, and access to digital health tools by rural facilities, providers, and patients.
States have until November 5, 2025 to apply for funds and this is the lone application period for the program. Awards will be announced by CMS by December 31, 2025.
West Coast Health Alliance Issues Winter Virus Vaccination Recommendations. On Wednesday, September 17, the West Coast Health Alliance (WCHA) issued its winter virus vaccination recommendations for residents of their region (California, Hawaii, Oregon and Washington). The recommendations include the 2025-2026 COVID-19, influenza, and RSV vaccines. The Health Officers of the WCHA and subject matter experts reviewed guidelines published from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians to derive the recommendations. This move also follows Governor Gavin Newsom (D) having signed AB 144 into law this week, which authorizes the state to base immunization guidance on independent medical organizations instead of the CDC’s Advisory Committee on Immunization Practices.
NASHP Annual Conference Concludes in San Diego. The National Academy of State Health Policy (NASHP) held its annual conference in San Diego last week. Topics of the sessions included high cost drugs, corporatization and consolidation of medical practice, and the future of Medicaid. HRSA Administrator Tom Engels addressed the conference during the final plenary session. Of note, prescription drug affordability boards were not discussed, despite NASHP’s endorsement of the existing boards. Legislators in attendance focused on transparency within drug pricing and private equity acquisition of medical facilities.
Florida
Surgeon General States Goal is to Ban mRNA COVID Vaccine. This past week, the Florida Surgeon General, Dr. Joseph Ladapo, iterated that he intends to ban mRNA vaccines from being used in the state. The statement comes after his and the Governor’s announcement last week that they intend to end all vaccine mandates over the course of the next year in the state. There has been no immediate response from the Department of Health or any other Florida administrative official on what, if any, policy steps the state will take to make that intent become reality. Dr. Ladapo has long been a critic of the mRNA technology and cautioned Florida residents from obtaining such a vaccine.
Georgia
GAO Releases Report on Pathways to Coverage Program. In recent weeks, the U.S. Government Accountability Office (GAO) released a report on Georgia’s Pathways to Coverage program. The program provides Medicaid coverage for those aged 19 to 64 who have a household income of up to 100 percent of the federal poverty level, inclusive of one person households. The GAO report found that the state has spent more on administrative implementation of the program than on the costs of rendering healthcare coverage and services for enrollees. From FY2021 to Q2 of FY2025, the state reported $54.2 million in administrative spending and $26.2 million on health care coverage and services. However, the administrative costs have reduced year-over-year significantly since 2023. Notably, the report attributes the high administrative costs to the initial implementation of the program, which required changes in determining eligibility, enrollment of individuals, and duplicative technology, training and coordination purposes. The Governor’s office has blamed most of the enhanced administrative costs on the litigation the program was embroiled in during the Biden Administration.
Illinois
State Releases Medicaid Managed Care RFP. This past week, the Department of Healthcare and Family Services issued their request for proposals (RFP) for the state’s Medicaid managed care program. Covering approximately 2.4 million enrollees in Illinois, managed care companies that bid are allowed to either bid on statewide coverage (of up to 5 awards will be granted) or Cook County only coverage (of up to 2 awards will be granted). The RFP calls for medicaid managed care companies to focus their materials on how they can deliver high-quality benefits with efficiency and effective service delivery, address social determinants of health, and how they can build out quality management via providers through incentives of a performance-based payment model(s), among other criteria. Responses are due from managed care companies November 13 and the Department intends to announce awards in February 2026.
Massachusetts
Supplemental Budget Bill to Support Hospitals Advances Through House Committee. This past week, the House voted to pass a $234 million supplemental budget bill that has the intent to stabilize financially strained hospitals and community health centers. H. 4530 would appropriate $199 million for acute care hospitals, $122 million of which would come in the form of targeted relief payments based on qualifying criteria which prioritizes the most cost-affordable hospitals, those with higher government payer mix and are experiencing significant financial strain. Additional $35 million would be appropriated for community health centers and an additional $2.5 million to the Massachusetts League of Community Health Centers for share service initiatives. The measure now heads to the Senate who had previously considered a similar funding mechanism this past summer.
Michigan
House Passes Legislation to Define Medical Decision-Making Responsibilities. On Thursday, the House of Representatives passed HBs 4418 and 4419 to update state statutes governing medical decision-making when a patient cannot make a determination of their own accord. Notably, HB 4418 authorizes surrogates to make health care decisions, inclusive of the selection and discharge of providers or facilities, approval or disapproval of diagnostic tests, and directions to provide or withhold all forms of health care except in certain circumstances. The bill also establishes a hierarchy of who would qualify as a surrogate in a situation where the patient has not readily identified an individual of choice. HB 4419 would provide a good faith immunity protection for providers and facilities which protects them from facing civil or criminal liability if they were to:
Comply with a healthcare decision of a person with surrogate authority;
Declining to comply with a health care decision of a person claiming to be the surrogate based on the belief that the individual lacked authority; and
Complying with a designation of patient advocate and assuming such designation was valid when made.
Both bills were passed unanimously in the House and they are currently sitting in the Senate waiting for committee assignment.
Washington
AI Task Force to Consider Prior Authorization Recommendation. At an upcoming Washington AI Task Force meeting scheduled for September 25, the Task Force will consider a number of recommendations that it intends to submit to the Legislature for consideration. Related to healthcare, Recommendation #5 will focus on prior authorization. As it currently stands, the recommendation is that AI systems should not be deployed in prior authorization processes as a substitute for the professional judgment of healthcare workers when making adverse determinations. Additionally, establishing transparency requirements on how payers are leveraging AI systems in their prior authorization processes, particularly if they are utilized in any way to deny, delay or modify health services. The recommendation also includes a requirement that payers conduct periodic impact assessments of their AI tools leveraged and that such tools are subject to independent auditing and reporting obligations.
