Weekly StateVitals Update: Volume 47 (November 24, 2025)

*Programming Note: There will not be a StateVitals Weekly Update on December 1, 2025 due to the Thanksgiving Holiday break. StateVitals Weekly Update will return to publication on December 8, 2025. 

Florida

• Senate Committee Passes Mandate on Medicaid MCOs to Ensure More After Hour Care Access. This past week, the Senate Health Policy Committee passed SB 40 through committee. The measure would require Medicaid managed care organizations (MCOs) to ensure at least 50 percent of its primary care provider network is available for Medicaid enrollees during off hours, albeit it is tiered down to 45 and 40 percent for small regions of the state. Notably, the new contracts that Medicaid MCOs signed earlier in 2025 require only 40 percent or more of their participating primary care providers to offer after-hour appointments by September 30, 2026. The measure is now the Appropriations Committee on Health and Human Services. 

Maryland

• PDAB Takes Next Steps to Set UPLs. This past week, the Prescription Drug Affordability Board (PDAB) determined that both Trulicity and Ozempic have created affordability challenges and should be considered for study and potential upper payment limits (UPLs) in the future. Additionally, the PDAB directed staff to develop methodologies that would establish UPLs for how much Medicaid and state and local governments would be allowed to pay for Farxiga and Jardiance. Both drugs are used in the treatment of Type 2 diabetes, in addition to other conditions. The PDAB will need to approve the UPLs at a future board meeting but it’s the clearest sign yet that the UPLs are forthcoming. It’s expected that the UPLs will be influenced by Medicare maximum fair price negotiations for the two drugs. Concerns from stakeholders still remain that such savings may not be immediately realized by the consumer but staff estimated that it would save state and local governments $12.9 million, though the estimate does not reflect rebates and discounts.

Nebraska

• State Submits 1115 SUD Demonstration Amendment. This past week, Nebraska submitted an 1115 substance use disorder (SUD) program demonstration amendment request to the Centers for Medicare & Medicaid Services (CMS). The amendment would expand federal financial match for state expenditures to cover short-term inpatient and residential treatment in IMDs for individuals with serious mental illness or emotional disturbance. Notably, the amendment also requests to add medical respite services for adults experiencing homelessness or housing instability. This amendment request is part of a broader effort to expand the state’s behavioral health treatment capacity. The public comment period is currently open through December 14, 2025. 

New York

• Office of Mental Health Announces $6 Million for Behavioral Health Crisis Response Teams. This past week, the New York State office of Mental Health announced that they will be making $6 million available for communities via grants to create behavioral health crisis response teams. The move comes as a result of a recommendation from Daniel’s Law Task Force which released a set of recommendations this past December to improve the community and law enforcement response to behavioral health calls. The $6 million grant funds will provide at least 3 grants of up to $2 million each to either establish a new response team or expand existing teams in operation. The three grants must be dispersed to a rural area, suburban area, and an urban area and must be used to train behavioral health professionals, inclusive of peer support services. 

South Carolina

• Restrictive Abortion Measure Fails to Advance out of Committee. This past week, a subcommittee of the Senate Medical Affairs Committee opted to vote against moving S. 323 to the full committee for consideration. The measure would have prohibited abortion care at conception and remove nearly all exceptions currently allowed under the state’s current six-week allowance time period. Only two republicans voted in favor of advancing the measure, while four other republicans opted not to vote, and three democrats voted against the bill. Notably, the bill under consideration also had a provision that would have authorized imprisonment for women up to 30 years if they violated the new law. This provision played a significant role in the measure’s defeat. While it’s unlikely this bill will move forward without changes following the subcommittee’s vote, it remains possible that it may be amended and brought back to the committee or its content amended into another legislative vehicle.

• Medicaid Program to Stop Covering GLP-1s. Despite implementing coverage only a year ago in November 2024, the state Medicaid program announced this past week that they are reversing course and will no longer cover weight loss drugs for obesity beginning January 2026. Originally implemented last year, South Carolina was the 14th state to cover weight loss medications for Medicaid members. Originally, the state expected coverage costs to come in at $3.3 million annually. However, in CY2024, the state realized $2.3 million state taxes that had to be paid and $5.5 million in federal taxes. The move also falls in alignment with recent action by the Trump Administration to reverse a considered policy by the Biden Administration that would have required state Medicaid programs to cover the cost of the drugs for qualifying Medicaid members. 

Wisconsin

• Senate Advances Measure Prohibiting State Funds for Healthcare of Undocumented Immigrants. This past week, the Wisconsin Senate passed A. 308. The measure is intended to prohibit the use of any state funds for paying for any healthcare-related services that immigrants lacking documentation may benefit from. Albeit, there is exception language for required funding of programs or payments made that are a result of existing federal law. Per the bill’s sponsor, the measure is also intended to prevent the Governor’s office from initiating any rulemaking that may authorize additional state dollars be spent on healthcare for undocumented immigrants. The Wisconsin Assembly passed the bill earlier this year and it now heads to the Governor’s desk.  

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.