Weekly StateVitals Update: Volume 49 (December 15, 2025)
National
CDC Vaccine Committee Overturns Hepatitis B Recommendation for Newborns. Recently, the CDC Advisory Committee on Immunization Practices (ACIP) voted to end the longstanding recommendation for all infants to receive a hepatitis B vaccine at birth. While the ACIP still recommends babies born to mothers who test positive for hepatitis B to receive a vaccine at birth, they released updated guidance recommending parents to postpone the first vaccine dose for all other infants for at least two months. Additionally, the ACIP voted to encourage parents to consider serology testing before approving additional doses of the hepatitis B vaccine. Critically, these guidelines do not go into effect until being approved by the CDC acting director, Jim O’Neill. While this likely will not prevent physicians from administering hepatitis B vaccines to newborns, ACIP recommendations have historically impacted insurance coverage of vaccines. It’s likely that states that utilize newly developed statutory or regulatory authority to deviate from such federal recommendations will choose to do so and instead revert to leveraging previously established recommendations related to the hepatitis B vaccine.
CMS Issues Guidance on Community Engagement Medicaid Requirements. This past week, CMS released additional guidance on how states should implement new community engagement requirements for Medicaid beneficiaries. These requirements apply to states that either expanded Medicaid coverage to non-elderly adults under a Section 1115 waiver or expanded coverage under the Affordable Care Act (ACA). The requirements apply to adults within the ACA’s new adult group or adults enrolled under a waiver with similar coverage. To meet these requirements, applicable individuals must spend at least 80 hours per month working, volunteering, or participating in a work or educational program, or earn at least $580 per month. Notably, CMS highlighted four key principles that will guide future policy development:
Centering the connection between health and work through community engagement;
Balancing the benefits of state flexibility with the potential systems and operational costs of options;
Aligning policies with existing statutory and regulatory requirements, including requirements for Medicaid, SNAP, TANF, IRS, and the ACA Marketplace; and
Ensuring the audibility of state community engagement determinations and verifications.
Moving forward, CMS must promulgate a final interim rule by June 1, 2026, and states have until January 1, 2027, to implement these requirements.
Colorado
New Behavioral Health Services Utilization Review Requirements. HB25-1002 takes effect on January 1, 2026. This bill requires insurance carriers to provide coverage for behavioral health, mental health, and substance use disorder treatment equal to the level of coverage for physical illnesses and to apply new utilization review criteria. Additionally, this law prohibits plans from limiting coverage for chronic behavioral health disorders to short-term symptom reduction at any level of care. Notably, while behavioral health parity laws have existed in Colorado for nearly two decades, insurers have been able to apply their own standards when determining coverage for behavioral health services. HB25-1002 ends this practice; insurers will now have to follow utilization review criteria consistent with the standards set by the American Society of Addiction Medicine. Moving forward, the Colorado Division of Insurance will release regulations regarding implementation.
Florida
House to Focus on Florida’s New Frontier in Healthcare in 2026 Legislative Session. Last Tuesday, House Speaker Daniel Perez (R) announced a new healthcare legislative initiative for the upcoming session. The initiative titled Florida’s New Frontier in Healthcare is centered around two bills: HB 693 and HB 697. HB 693, or the Big Beautiful Health Care Act, lists several provisions on healthcare reform, including:
Restricting Medicaid, CHIP, and SNAP eligibility for certain individuals without US citizenship.
Reducing the time period for retroactive Medicaid payments to two months.
Prohibiting the Agency for Health Care Administration (AHCA) from making payments to prohibited entities that provide abortions.
Repealing the certificate of need program for nursing homes, hospice services, and intermediate care facilities for individuals with developmental disabilities.
Enacting interstate licensure compacts for EMS personnel and physician assistants.
Authorizing autonomous practice requirements for APRNs.
Expanding the scope of practice of dental hygienists.
Removing the supervisory cap on physician assistants.
Requiring healthcare practitioners to notify patients of out-of-network referrals and apply payments toward insureds’ deductibles and out-of-pocket maximums.
The other landmark bill, HB 697, also known as the PRICE Act, focuses heavily on drug pricing and PBM reform. Its provisions cover:
Establishing an international drug reference pricing system to set maximum prices for prescription drugs in the state.
Requiring drug manufacturers selling in the state to report international pricing data to the AHCA.
Requiring pharmacies to charge cash-paying customers no more than the established prescription drug reference price.
Requiring health insurers and HMOs to limit reimbursement for prescription drugs to the established reference price and use the resulting savings toward reducing enrollees’ premiums and cost sharing.
Prohibiting insurers and HMOs from removing a covered prescription drug from a formulary or increasing its cost-sharing during the policy year.
Requiring PBMs to reimburse non-affiliated pharmacies at the same rate as affiliated pharmacies.
Prohibiting PBMs from creating formularies that require patients to use drugs from affiliated manufacturers when a generic or biosimilar equivalent is available.
The Legislature will convene on January 13, 2026, and it’s expected that the Speaker will be proactive in pushing both measures through the committee process.
Indiana
Indiana Appeals Court Blocks Release of Individual Abortion Reports. This past week, the Indiana Court of Appeals upheld a Marion County judge’s order to prohibit the Department of Health from releasing terminated pregnancy reports (TPRs) filed by doctors. The panel of 3 unanimously agreed that the reports should be protected as “patient medical records.” The case, brought by OB-GYNs Dr. Caitlin Bernard and Dr. Caroline Rouse, follows a previous controversy from 2023 where Dr. Bernard publicly discussed the abortion she provided for a 10-year-old rape victim. This discussion prompted anti-abortion groups to successfully request the release of the patient’s TPR as public records. Historically, the Department of Health released individual TPRs, but after the state’s near-total abortion ban in 2022, they switched to quarterly reports, given far fewer abortions and an increased likelihood of a patient being identified from the report. Dr. Bernard and Dr. Rouse have gone on to release a statement that they welcomed the decision’s “affirmation of our patients’ right to privacy.” In the coming months, the State Health Commissioner can still appeal the decision to the Indiana Supreme Court.
Michigan
Governor Whitmer Signs Bills to Lower Costs for Michigan National Guard Members and Their Families. Last Tuesday, Governor Gretchen Whitmer signed 3 bills: SB 370, SB 540, and SB 542 into law. Along with HB 4962, which creates the Michigan National Guard member benefit fund, these bills complete a four-bill package that extends reimbursements and assistance for healthcare, childcare, and tuition costs for the Michigan National Guard. More specifically:
SB 370 creates a Tricare premium reimbursement program covering both health and dental premiums for members of the TRICARE Reserve Select and TRICARE Dental programs.
SB 540 creates the Michigan National Guard child care assistance program, which provides stipends to single parents or couples who are both active service members.
SB 542 creates the Michigan National Guard Tuition Act to pay for vocational or technical training, certificates, and members’ first undergraduate or graduate degrees.
The annual reimbursement amounts are yet to be determined and are subject to the discretion of the Michigan National Guard General Adjutant Paul D. Rogers. At the end of the month, the Legislature is scheduled to take a two-week break and will resume session starting January 14, 2026.
Mississippi
Attorney General Issues Recommendations on Opioid Settlement Funds. This past week, Attorney General Lynn Fitch (R) issued recommendations on behalf of Mississippi’s Opioid Settlement Advisory Council to the Legislature for consideration. The recommendations included a list of applications that the Council is suggesting be funded, with $40 million worth of grant funding prioritized in a first tier and an additional $41 million in a second tier. Notably, the Legislature had established the Council this past year to provide targeted recommendations on how the state should spend its opioid settlement money based on an assessment of applications submitted. More than 127 applications were ultimately submitted as part of the process. It’s expected that a second round of applications will be done in the coming months. The Legislature will consider whether to appropriate funds to authorize the Council’s recommendations this next session in 2026.
Senate Study Group Issues Healthcare Recommendations to Legislature. This past week, the Senate Study Group on Women, Children and Families issued recommendations to the Legislature on how the state should invest in healthcare opportunities for women and children. Notably, the study committee, which was formed in 2022 and includes lawmakers, recommended possible reform of the state’s Child Care Tax Credit. The credit offers a 50 percent income tax credit for employers who provide their employees with child care during the work day or provide at least $6,000 in a stipend to a licensed childcare provider for their employees. There’s been little uptake in the tax credit due to cost and the study group wants to amend the $6,000 cap to make it more accessible for mid-size employers. The study group also provided insight on the risk of taking fluoride out of drinking water and told the Legislature to be prepared to accommodate increased Medicaid costs as a result. Another proposal would establish family support groups in the state to help families develop skillsets to support family members battling addiction, with a focus on mothers. It’s unclear whether the Senate will take up on any of these recommendations for consideration as they head back into secession in 2026.
New York
Governor Hochul Signs Bill Requiring Hospitals to Implement Language Assistance Programs. This past week, Governor Kathy Hochul (D) signed S. 6288B / A. 387B into law. The measure requires general hospitals in the state to develop and implement a language assistance program within the facility. Notably, the bill requires that such programs must include the designation of a language assistance coordinator, policies and procedures that allow for timely identification and access for patients to such services, continuing education for hospital staff, appropriate signage that reflects that availability of such services, and the provision of skilled interpreters and other staff skilled in communication with vision or hearing-impaired individuals. Some version of this measure has been introduced for the past decade and agreement was finally reached to get it across the finish line.
North Carolina
Governor Stein Cancels Medicaid Rate Cuts. Last Wednesday, Governor Josh Stein confirmed that he is cancelling the Medicaid reimbursement rate reductions implemented in October. The rates will be restored to September 30, 2025, levels. While the reductions were intended to address the current $319 million shortfall, months of stalemate between the legislative chambers and ongoing litigation from the North Carolina courts have forced the Department of Health and Human Services (DHHS) to reverse the cuts. As it stands, North Carolina is the only state in the country without an enacted budget, and DHHS Secretary Devdutta Sangvai highlighted that current projections estimate Medicaid running out of funding in March or April 2026. In the meantime, DHHS will begin to reprocess claims submitted since October 1st.
Trial Court Upholds CON Laws in the State. This past week, a three-judge Trial Court upheld the constitutionality of the state’s certificate of need (CON) law for healthcare services and facilities and dismissed a complaint that such law violated a practitioner’s ability to render care in what was otherwise a “monopoly.” The decision follows a year’s long effort and challenge by an ophthalmologist to the state’s CON laws. Back in October 2024, the North Carolina Supreme Court issued a unanimous ruling requiring this trial court to undertake a broad trial to determine whether certificate of need laws in the state are unconstitutional. At issue is the ophthalmologist’s complaint that he could perform a certain cataract surgery for $1,800 while the local hospital charges $6,000 for the same procedure. However, the ophthalmologist contends he is prohibited from purchasing the equipment necessary to perform the procedure because certificate of need rulings have been issued iterating that only the hospital may perform such a procedure in the defined geographic area. The most recent ruling by the Trial Court is expected to be appealed.
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.
