Weekly StateVitals Update: Volume 45 (November 10, 2025)

National 

• All 50 States Apply for the Rural Health Transformation Program Funding. This past week, the Centers for Medicare & Medicaid Services (CMS) announced that all 50 states had submitted applications for the Rural Health Transformation Program, a $50 billion grant program to be distributed to states over five years. As previously highlighted in past Weekly StateVitals Updates, the program had an application period from September 15 to November 5, 2025. Awards will be announced by December 31, 2025, with funding distributed over five years. $25 billion will be distributed equally across all fifty states while the remaining $25 billion will be awarded through a merit review process by CMS. 

• Federal Government to Partially Fund SNAP. Following a Rhode Island federal judge’s order to distribute money owed to recipients of the Supplemental Nutrition Assistance Program (SNAP) as soon as possible, the U.S. Department of Agriculture released a filing this past week that indicates its intent to comply with the order and fulfill an obligation to expend SNAP contingency funds as available. However, as part of its compliance, the Administration contends that it can only partially fulfill SNAP benefits for the month of November. Noting that it cannot fund SNAP using child nutrition funds because it would decimate that account (i.e., 29 million children receiving free school meals). In lieu of opting to move forward with that funding lane, the administration instead will fund SNAP benefits with the remaining $4.65 billion in contingency funds which is expected to cover up to 50 percent of eligible households’ current allotments. 

• NASHP to Hold Webinar on New Site-Neutral Payment Model Legislation. The National Academy of State Health Policy (NASHP) intends to host a webinar on November 18th to provide an overview and discussion on its recently published site-neutral payment model legislation. The model is based on the Medicare Payment Advisory Commission’s recommendation from 2023 that proposes certain outpatient service payments should be aligned across delivery sites. Two individuals involved in drafting the model language, Jessica Zhang from the Building Service 32 BJ Health Fund and Erin Fuse Brown from the Center for Advancing Health Policy through Research will take part in the webinar. At this time, it’s unclear whether there is traction from states to pick up the model language for introduction in 2026 or future years. 

Arizona

• Governor Launches Prescription Drug Discount Cards. Governor Katie Hobbs (D) launched AZRx this past week, an initiative that allows Arizona residents to sign up for a drug discount card through ArrayRx. ArrayRx is a public pharmacy collaborative that Arizona joined earlier this year. Besides Arizona, Connecticut, Nevada, Oregon and Washington also participate in the program. The initiative will be available to all residents, regardless of insurance status. It’s estimated that residents will save up to 80 percent on medications utilizing the discount card program. This launch follows an executive order that had been previously signed by the Governor.

Colorado

• Manufacturer Sues the PDAB. After the Colorado Prescription Drug Affordability Review Board (PDAB) opted to place a price cap on the rheumatoid arthritis drug Enbrel last month, the drug’s manufacturer, Amgen, has opted to file suit to block the move. The Colorado PDAB set a $600 cap for a standard weekly dose. Amgen claims in its suit that the upper payment limit (UPL) is unconstitutional and stands to cause irreparable financial harm. Amgen had previously sued the state after the PDAB selected Enbrel for a UPL. However, a court dismissed the claim, citing a lack of standing since it was unlikely to cause harm to the manufacturer. Now that a UPL has formally been set, legal experts believe that this will be the vehicle to determine their legal viability moving forward. Notably, the lawsuit alleges the UPL  and the process the PDAB utilized to determine its amount violated the U.S. Constitution’s supremacy and commerce clause, in addition to due process protections under the 14th Amendment. Essentially arguing that the PDAB is attempting to regulate economic activity outside of Colorado and that the UPL  conflicts with federal patent authority as defined under existing law. Currently, the price cap on Enbrel isn’t set to go into effect until January 2027. 

• Governor’s Budget Releases Proposed FY26-27 Budget and Tightens Medicaid Spending. Governor Jared Polis (D) recently released his proposed budget plan for the next fiscal year. A significant priority of the Governor’s is to reduce Medicaid spending in the state, noting in remarks during a recent press conference that Medicaid spending has increased at a rate of 8.8 percent per year, which is more than double the amount the state is allowed to increase total spending for the state per the state’s Taxpayer’s Bill of Rights. During the press conference, the Governor noted that the increased Medicaid costs on this trajectory would “crowd out” everything else the state does. Specifically, the proposed plan calls for increasing Medicaid spending by only $300 million in the next fiscal year, $331 million less than what the state estimates is needed to cover increased projected costs if the state were to retain its Medicaid offerings as it currently stands. 

  The Governor intends to realize Medicaid cost savings through a myriad of avenues. This includes codifying a recent executive order that the Governor signed that cuts up to $15 million in spending this fiscal year and is inclusive of Medicaid reimbursement rate caps for providers and establishing limitations on dental benefits for Medicaid members. Other cost-savings avenues are expected to include limiting home caregiver hours eligible for reimbursement and amending reimbursement rates for individuals supervising individuals with autism.

New York

• New York Issues First Ever Report on Maternal Mental Health. Last week, Governor Kathy Hochul (D) announced the release of the state’s first maternal mental health report, which details challenges pregnant individuals face and recommendations for improvements statewide. Notably, the report’s recommendations focus on policy and operational investments and changes that can be accomplished within two years. Those recommendations include expanding the Collaborative Care Medicaid Program in maternal health practices, support the expansion of dyadic care, invest in 988 crisis counselors for specialized maternal mental health screenings, and promote the availability of doula coverage in Medicaid, among a multitude of other recommendations. The Governor also announced that the Office of Mental Health in the state is providing $850,000 to extend the Collaborative Care Model to provide greater access for maternal patients. 

North Carolina

• Governor Calls Legislature Back to the Capitol to Fund Medicaid. After leaving Raleigh without agreement on a new state budget, Governor Josh Stein (D) has called lawmakers back to the Capitol for a special legislation session expected to take place later this month. The Governor noted that the main issue for movement during the special session is Medicaid funding. Disagreement remains between the House and the Senate as to how to approach said funding package and Governor Stein has iterated his concern that there’s no guarantee the Legislature would approve a new budget next year. The Governor has highlighted that it is irresponsible to fund Medicaid at levels beyond what’s currently approved. While the Governor can call the Legislature back into a special session, the Legislature could technically just gavel out without taking any action. 

Pennsylvania

• State Court Hears Oral Arguments in Medicaid Abortion Care. This past week, the Pennsylvania Commonwealth Court system heard oral arguments in a case that seeks to remove state restrictions on Medicaid coverage for abortion care. Pennsylvania Medicaid will only cover abortion services if it is a circumstance of rape, incest or the life of the mother is at grave risk. Abortion care providers have challenged that limited coverage arguing that the state constitution provides enhanced protections for reproductive health care access and that Medicaid’s exclusion of such coverage violates the constitution’s protections. Last year, the state’s Supreme Court had ruled that the coverage exclusion was presumptively unconstitutional but remanded the issue back to lower court. The court must now decide whether the coverage exclusions violate the state’s Equal Rights Amendment and if there is protection to such services under the state’s constitution. It’s unclear when a ruling will come down. 

Texas

• Proposition 14 Passed and Funds Dementia Initiative. This past week, Texas voters approved by a 68 to 32 margin Proposition 14. The constitutional amendment establishes a Dementia Prevention and Research Institute of Texas and authorizes an appropriation of $3 billion to set up the fund. An initiative led by Lt. Governor Dan Patrick this past year, it was modeled after the state’s existing cancer research fund. It’s expected that the $3 billion will be appropriated utilizing surplus state revenue and after the first year, the effort will see up to $300 million appropriated in each subsequent year. The intent in part is to also help attract physicians and other experts in the field of memory loss related disorders to the state.

• New York Judge Dismisses Texas Challenge to Shield Law. Recently, a New York state court opted to dismiss a legal challenge filed by Texas Attorney General Ken Paxton seeking to enforce a $100,000 civil judgment against a physician accused of prescribing abortion pills to a patient in Texas. One of eight states with a shield law, the Court ruled that a county clerk who refused to file the civil judgment in New York was correct to do so as the refusal followed New York law. As the Court found, the medical services the physician rendered are legal in the state and fall within the definition of legally protected health activity under the state’s shield law. It remains unclear whether the trial court’s decision would be appealed by the Texas Attorney General.

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.