Weekly StateVitals Update: Volume 42 (October 20, 2025)
National
Fifteen Governors Launch the Governors Public Health Alliance. This past week, the Governors of fifteen states launched a public health alliance with the intent to improve public health coordination and emergency preparedness across state lines. In the Governors’ joint statement, it’s noted that the Alliance will serve as a hub for Governors and public health officials to share best practices, exchange data and collaborate on emergency response, develop and respond to needed vaccine policy and provide alignment on other technical issues. The move comes as states continue to iterate growing concern with the Trump Administration’s recently revised vaccine guidance in advance of the winter months and continued concern by Democratic governors with the role of the National Governors Association in providing such a central hub. The Governors involved are from the states of Colorado, California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Carolina, Oregon, Rhode Island, Washington and Guam.
NASHP Releases New Model Law on Site Neutrality. Recently, the National Academy of State Health Policy (NASHP) published a new model law which models adoption of a Medicare Payment Advisory Commission (MedPAC) recommendation that some services that can be provided safely in non-hospital settings should be paid on a site neutral basis. The model law had come at the request of some states that proactively participate in NASHP and is intended to ensure that services in non-hospital settings are priced the same as hospital settings. NASHP has iterated that additional materials to support the model law will be published in the coming months.
California
Governor Signs PBM Licensure Bill into Law. Governor Gavin Newsom (D) has signed SB 41 into law. The bill is the latest effort by the state to enhance oversight of pharmacy benefit managers (PBMs). It requires that all PBMs in the state must be licensed by the Department of Insurance, mandates that PBMs pass rebates on to the payer or patient, prohibits PBMs from making exclusivity deals with manufacturers, and prohibits certain practices of PBMs. Two of these practices include requiring use of only an affiliated pharmacy or imposing any limitations or conditions that would discriminate against a nonaffiliated pharmacy. Additionally, the bill prohibits insurers from calculating an enrollee’s cost sharing at an amount exceeding the actual rate paid by the insurer for the prescription drug. Finally, the legislation makes California the second state to adopt a flat-fee structure for PBM income.
Governor Signs CARE Court Expansion Measure into Law. Recently, Governor Gavin Newsom (D) signed SB 27 into law. The measure seeks to expand access to California’s Community Assistance, Recovery and Empowerment (CARE) Act and the resources available under the Act. Notably, the CARE Court under the original Act authorized in 2022, was intended to provide a program that allowed family members, first responders, doctors and others to petition the courts on behalf of individuals who experience psychosis as a result of schizophrenia and lacked the ability to care for themselves. This law would expand eligibility to the CARE Court to include individuals who experience psychosis due to bipolar disorder. Before the expansion, it was estimated that utilization of the CARE court was limited in nature and reached only a few hundred individuals. It’s unclear how this expansion will impact the court’s utilization but some estimate anywhere from a 3.5 to 48 percent increase. The legislation also creates additional efficiencies in the CARE Court through combining two early court procedural hearings into a single one, hoping to reduce the time participants have to spend in court.
State to Begin Selling Insulin Under Own Label. Beginning this next January, California will begin selling insulin under its own label. Working with nonprofit Civica, the CalRx brand of insulin will be available at a recommended price of $11 per pen and a maximum of $55 for a five-pack. No prescription will be required to purchase the CalRx insulin. The state legislature had originally invested $100 million into the project in 2022, with $50 dedicated to developing three types of insulin and the rest set aside to invest in a manufacturing facility. Notably, Civica has noted that its distribution of this new generic insulin will also be distributed nationwide to pharmacies.
Florida
Analysis Finds Significant Disenrollment from KidCare Program. In recent weeks, a non-profit news outlet, the Florida Phoenix, has found and reported that a state report found that 43,000 children had been disenrolled from the Florida KidCare program for nonpayment of premiums. Florida KidCare is the state’s Children’s Health Insurance Program (CHIP) for uninsured children who meet income and eligibility requirements. The report found that more than 17,000 children had been disenrolled from coverage between September 2024 and August 2025 for failure to pay premiums and that group of children were never re-enrolled in the program. An additional almost 26,000 children were disenrolled after failure to pay the premium but were eventually re-enrolled during the 12-month period once premiums had been paid. This happened as the state was in negotiation with the Centers for Medicare & Medicaid Services (CMS) to implement a 2023 Florida law which would have increased the eligibility for the program by increasing the ceiling for qualifying income to 300 percent of the federal poverty level for the family of the child. However, the Administration had been hesitant to implement that law because CMS at the time was requiring the state implement 12-month continuous eligibility for certain eligible children enrolled in the program.
Auditor General Criticizes DBPR for Lack of Oversight of Division of Drugs, Devices and Cosmetics. This past week, the Florida Auditor General criticized the Department of Business and Professional Regulation (DBPR) during his presentation before the House Administration Budget Subcommittee. The criticism is largely due to an operational audit related to controlled substances that took place between 2022 and 2023 and focused on wholesaler and manufacturer prescription drug purchasing activity that DBPR is expected to monitor. Outlining a produced report with legislative recommendations for enhanced oversight of monitoring programs at the DBPR, the Auditor General argued that monitoring efforts were not adequate to ensure entity compliance with state law or adequate protection for the health, safety and welfare of the public. Notably, the report highlights recommendations that focus on changing management controls, improving security and information technology controls, and increasing cybersecurity controls.
Mississippi
Senate Study Committee Explores Health Insurance Solutions. Recently, the Insurance Study Committee, established via SB 2401 enacted in March, met to discuss potential legislative recommendations to address the growing costs of healthcare insurance and coverage gaps in the state. The meeting followed previous research meetings where committee members heard from subject matter experts and state personnel on likely key variables for consideration. In its most recent meeting, the Mississippi Independent Physician Practice Association (MIPPA) spoke at length about whether a few health insurers had a “monopoly” on providing coverage in the state. MIPPA recommended solutions inclusive of prohibiting unilateral contracts by insurers and enhancing transparency in the insurers’ rate setting process for consumers and reimbursement setting process for providers. The Committee took no action on the recommendations but is expected to meet October 29th for its next meeting. The Committee is planning to provide a report to the Legislature with recommendations by December 1, 2025.
North Carolina
Governor’s Administration Provides Update on Medical Debt Relief Program. This past week, Governor Josh Stein (D) and his administration offered an update on a state government program authorized under his predecessor to provide medical debt forgiveness for qualified residents utilizing Medicaid dollars. Negotiated in 2024, hospitals and the Administration came to an agreement that hospitals that participated in medical debt forgiveness initiates would be eligible to receive higher Medicaid reimbursement via assessment funds. The program was eventually approved by the Centers for Medicare & Medicaid Services. Governor Stein announced that to date 2.5 million residents have had $6.5 billion in medical debt eliminated through the program. The residents eligible for the program are those that are low and middle income patients. The state hospital association continued to reiterate its concern that this program, and others, would limit the ability of hospitals to expand their services to reach residents.
For additional information and updates on state activity this past week relative to state COVID-19 vaccine guidance, StateVitals Subscribers can check out our guidance tracker.
