Weekly StateVitals Update: Volume 54 (February 2, 2026)
National
CMS Announces Private Company Investment in Medicaid Work Requirements Implementation. This past week, the Centers for Medicare & Medicaid Services (CMS) announced that 10 health technology companies with existing state contracts to assist with Medicaid eligibility and enrollment will voluntarily help states prepare and implement Medicaid work requirements as required under the One Big Beautiful Bill Act. These ten companies indicate that they intend to offer states they are currently contracted with more than $600 million in no-cost and significantly discounted technology products and services to support the work requirements implementation. These ten companies include Accenture, Acentra Health, Conduent, GDIT, Deloitte, Gainwell, Maximus, Curam by Merative, Optum, and RedMane. Notably, these companies seek to drive better alignment and operational power for states to expand testing environments and support automated, consent-based data verification for income, education and other related activities.
CMS Issues Final Rule on Non-Uniform or Non-Broad-Based Provider Tax. This past week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that codifies statutory changes outlined in this past summer’s reconciliation bill that prohibits health care related taxes to tax Medicaid providers at a higher rate than non-Medicaid providers. The final rule, and underlying statutory language, also prohibit a tax on high-volume Medicaid providers at a rate different than low-volume Medicaid providers. Additionally, the Final Rule stipulates that Medicaid managed care organization taxes approved within two years leading up to the rule’s effective date must comply by January 1, 2027, for those approved more than two years before the rule’s effective date must be in compliance by the state FY2028. All other provider taxes must be in compliance by the state FY2029.
State Marketplace Network Releases State-Based Marketplace Enrollment Data. This past week, the State Marketplace Network, a consortium of state leadership of state-based health insurance marketplaces and state-based marketplaces that use the federal platform, released marketplace enrollment data from their collective states. While current data does not indicate the severity of disenrollment from state-based marketplaces (SBMs) for PY2026, SBMs are already facing significantly high disenrollment rates as a result of the enhanced Advance Premium Tax Credits (eAPTCs) no longer being available. Notably, Colorado is reporting cancellations of policy at a rate 83 percent higher than the previous year and Idaho and Pennsylvania are seeing four times the rate of disenrollment compared to last year. Additionally, initial data illustrates that more consumers are purchasing lower premium plans with higher out-of-pocket costs and state subsidy programs established to help mitigate the elimination of the eAPTCs remain lacking in incentivizing consumers to re-enroll. Many SBMs have extended their enrollment periods through the end of January, and some are seeking an extension through February.
Department of Justice Requests Federal Court to Pause Mifepristone Case. On Tuesday, the Department of Justice filed a motion to pause a Louisiana lawsuit against the Food and Drug Administration to reinstate in-person dispensing requirements for mifepristone. The Justice Department argued that judicial action could be unnecessary and disruptive in the face of the FDA’s review of the drug’s safety. Furthermore, the administration claimed the state lacked standing and should instead focus on suing abortion medication providers instead of the administration. The basis of Louisiana’s lawsuit stems from a change made by the FDA in 2023 that allows mifepristone to be prescribed via telehealth and delivered by mail order. The suit was originally filed by Attorney General Liz Murrill (R) on October 6, 2025, who was joined by a woman claiming her boyfriend coerced her into taking mifepristone obtained from a California doctor. The court is expected to decide on the motion to stay the case ahead of the hearing on February 24.
California
Psychiatric Hospital Emergency Staffing Rules Delayed after Public Backlash. This past Monday, the California Department of Public Health delayed emergency staffing rules for acute psychiatric hospitals following significant backlash from hospitals, nurses, and other healthcare stakeholders. The rules, established by AB 116, were set to go into effect Jan 31, about a month after the department first published them. Instead, they are now effective June 1. The rules require acute psychiatric hospitals to have at least one licensed nurse per six adult patients, or per five pediatric patients, at all times. Moreover, the rules directed the Department of Public Health to fine hospitals $15,000 to $30,000 for each day of noncompliance. Opponents of the original implementation timeline claimed that the imposed staffing requirements would lead to the closure of hundreds of psychiatric beds. The staffing requirements themselves are in response to an investigation linking higher rates of physical assault, sexual assault, and death to low staffing levels at for-profit acute psychiatric hospitals. With the extended deadline, acute psychiatric hospitals are expected to continue recruiting, hiring, and training nurses to sustain the new minimum staffing ratios.
Florida
Senate Committee Advances Bill Enhancing Vaccine Exemptions. This past week, the Senate Committee on Health Policy opted to vote 6 to 4 to advance SB 1756 out of committee. The now amended measure, known as the Medical Freedom Act, establishes a prohibition on the State Health Officer from having authority to order a vaccination for any resident. However, it also establishes conscience protections as an exemption pathway from school-entry vaccine requirements. For providers, the bill would also do the following of note:
Require providers to provide state-approved informational materials and obtain signed informed consent from a parent or guardian before administering a vaccine to a minor.
Establishes immunity for providers whose license does include prescribing authority from civil or criminal liability and disciplinary action for prescribing or administering ivermectin to an adult.
Authorizes pharmacists to provide ivermectin to adults without a prescription as a behind the counter medication.
The bill is now headed to the Appropriations Committee for consideration.
Indiana
Senate Passes Bill Authorizing Civil Lawsuits Against Abortion-Inducing Drug Distribution. Last Tuesday, SB 236, which allows people to sue anyone who manufactures, distributes, mails, transports, delivers, prescribes, or provides abortion-inducing drugs in the state, passed the Senate in a 35-10 vote. This civil enforcement mechanism comes through newly created liabilities for wrongful death and personal injury placed upon individuals aiding in the drugs distribution. Additionally, the bill contains provisions that:
Require the Department of Health to publish more in-depth abortion complication reports
Modify the definitions of abortion and abortion-inducing drugs
Prohibit Indiana courts from enforcing an out-of-state judgment obtained in an action brought under a clawback provision
Impose liability for the state's legal fees on parties who unsuccessfully challenge any state abortion law in court
Require courts to award plaintiffs at least $100,000 per violation in addition to attorney’s fees
This legislation comes in the wake of several state lawsuits against abortion drugs such as Mifepristone and their distribution via mail. Currently, Texas’s and Louisiana’s lawsuits are testing states’ authority to enforce abortion bans against other states’ shield laws. Moreover, both of these states have enacted legislation that authorizes action against individuals who provide abortion medication, similar to SB 236. As for Indiana, SB 236 is currently under consideration in the House, where legislators are expected to deliberate in the coming weeks.
Massachusetts
State Releases Roadmap for 1115 Demonstration Extension. Recently, the Massachusetts Executive Office of Health and Human Services (EOHHS) announced their plans for how they intend to approach an extension and amendment application for the state’s 1115 Demonstration. The intent is for the demonstration to be extended from 2028 to 2032 and include numerous structural changes to accommodate transformation in the private sector and recent policy shifts since the initial demonstration was implemented. In its roadmap, the EOHHS proposes continued refinement of MassHealth’s value-based ACO program through authority to run a ACO program focused on primary care sub-capitation, enhance behavioral health inpatient and diversionary services care models, and continue to invest in addressing health-related social needs services, among other provisions. It’s expected that the 1115 extension application will be available for public comment in summer or fall of 2026 with an application submitted to CMS by the end 2026.
Michigan
House Committee Advances 340B Measure. This past week, the House Health Policy Committee voted to advance HB 4878 out of committee. Similar to efforts in past years, the measure would prohibit manufacturers and wholesalers from denying, restricting, prohibiting or otherwise limiting in any way the acquisition of a 340B drug by a 340B covered entity, inclusive of a 340B entity’s contract pharmacies. The measure would also require drug manufacturers to report to the Legislature and Department of Licensing and Regulatory Affairs any prescription drugs that exceed $40 for the cost of 1 course of treatment and that has had an increase of 15% in wholesale acquisition cost during the preceding 12 months. The bill now heads to the Rules Committee.
Nebraska
Nebraska Reverses Planned Caregiver Cap on Aged and Disabled Medicaid Waiver. This past Tuesday, Governor Jim Pillen (R) announced that the Department of Health and Human Services would not move forward with the proposed change to cap Medicaid charges for caregiver hours. Gov. Pillen noted this change came in response to vast public input from families and waiver recipients. The state’s current waiver allows older adults and people with disabilities to receive long-term care in their communities or at home rather than in larger facilities. In his recent budget proposal, Gov. Pillen proposed capping live-in caregivers at 40 weekly hours and authorizing 30 additional hours for care provided outside of the home. Now, the previous weekly limit of 112 live-in caregiver hours will be maintained for the majority of waiver recipients. As it stands, the state’s current five-year waiver expires July 31, and future waivers will require federal approval. The waiver will now enter a second public comment period, running from February 2 to March 4.
Oklahoma
Executive Order Intends to Enhance Oversight of Medicare Advantage Plans. Recently, Governor Kevin Stitt (R) issued an executive order that intends to enhance oversight of how Medicaid Advantage (MA) plans are operated and advertised in the state with the intent to decrease burden on providers and consumers. Notably, the EO instructs policy changes that could raise questions as to federal preemption of existing federal law which ultimately governs MA plans. The notable elements of the EO include:
MA plans are prohibited from offering inducements, bribers or other benefits to influence beneficiary plan selections and may only offer CMS-approved supplemental benefits to potential MA enrollees.
Requires MA plans to be truthful in marketing and enrollment practices and establishes a prohibition on employing “high pressure” tactics or misleading representations in their offerings.
MA plans are required to adhere to a 14-day prompt payment standard to providers with clean claims and prohibits any improper denial for traditional Medicare services.
MA plans are required to maintain sufficient provider networks that ensure access to care in the counties in which offerings are made and MA plans are required to follow either CMS or Oklahoma Insurance Department (OID) standards, whichever is more stringent.
MA plans will be required to submit data on payments, networks, and denials to the OID annually.
The EO requires OID and the Oklahoma Health Care Authority to issue rules and guidance to implement this EO within 90 days.
Rhode Island
Governor’s Budget Proposal Includes Dropping Medicaid Coverage of GLP-1s for Weight Loss. This past week, Governor Dan McKee (D) issued his FY2027 proposed budget. With Medicaid costs having increased by a multiplier of four between 2024 and 2025, the Governor’s office is proposing ways to reduce Medicaid costs. Part of that is removing GLP-1s from the Medicaid formulary if utilized for weight less. That move is expected to save the state $6.3 million in general revenue. If it’s approved by the Legislature, coverage would cease for Medicaid enrollees as of October 1, 2026. The budget proposal will go through Legislative negotiations beginning in February with a final budget not expected until sometime in June.
Texas
Attorney General Paxton Files Second Lawsuit Against Out-of-State Abortion Medication Provider. On Tuesday, Attorney General Ken Paxton (R) filed a lawsuit against Deborah Lynch, a Delaware nurse practitioner who operates an online clinic that prescribes and delivers medication packages containing abortion medications mifepristone and misoprostol. In the lawsuit, AG Paxton alleges that Lynch’s clinic sent the abortion-inducing drugs to women in several cities across Texas. For this, the state is suing Lynch for violating Texas’s law banning abortions that are neither medically necessary nor performed by a physician, as well as for practicing medicine without a valid license to practice in Texas. This joins Texas’s previous lawsuit against a provider in New York for providing abortion medication to a woman in Texas. Both Delaware and New York have state “shield laws” that protect providers from out-of-state prosecution for delivering health care services that are legal in their home state. As these lawsuits unfurl in the coming months, they will provide insight to the strength of state shield laws and the ability of other states to enforce abortion bans against providers in states that have them.
Virginia
PDAB Bill Moves Out of Senate Committee. This past week, SB 271 passed through the Senate Commerce and Labor Committee on a 10 to 4 vote. Similar to previous years, the bill establishes the Prescription Drug Affordability Board (PDAB) to conduct affordability reviews of prescription drugs and establishes an upper payment limit (UPL) setting authority on drugs found to pose affordability challenges. Notably, the UPL is tied to the federal maximum fair price established through Medicare price negotiation. The bill also provides the PDAB with the ability to conduct affordability reviews. The measure had previously been passed by the Senate Education and Health Committee and is now expected to be considered on the Senate floor. It remains unclear whether the Governor’s office will be more receptive to a PDAB model than the previous Governor.
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.
