Weekly StateVitals Update: Volume 60 (March 16, 2026)
National
CMS Releases New Implementation Details on the BALANCE model. Last Monday, the Centers for Medicare and Medicaid issued new implementation details for the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model. The model aims to increase access to GLP-1 medications for Medicaid and Medicare Part D beneficiaries. Beginning January 1, 2027, participating drug manufacturers will offer GLP-1s through Part D plans to most beneficiaries at a maximum out-of-pocket cost of $50 per month after they meet their deductible. Before the deductible is met, beneficiaries’ cost-sharing will be capped at $245 plus a dispensing fee. Before the BALANCE model is effective, CMS is also releasing the Medicare GLP-1 Bridge Model, which will provide Part D beneficiaries with access to GLP-1s at a maximum out-of-pocket cost of $50 per month with no deductible, from July 1, 2026, to December 31, 2026. State Medicaid programs can join the BALANCE model beginning May 1, 2026, with a rolling start date.
GAO Releases Vision and Dental Insurance Market Consolidation Report. On Monday last week, the Government Accountability Office (GAO) released a report on market concentration among dental and vision insurers nationwide. In its report, GAO found that concentration varied across states. For dental insurance, the combined market share of the three largest providers ranged from 38% (LA) to 97% (DE and HI). In terms of vision insurance, the combined market share of the three largest providers ranged from 41% (LA) to 95% (DC). The GAO did not conclude how highly concentrated dental and vision markets could affect consumers and found no evidence of consumer harm due to concentration or vertical integration. The report opted not to include any recommendations for further consideration on either a legislative or regulatory level.
Alabama
DLR Measure Passes Senate Committee. This past week, the Alabama Senate Banking and Insurance Committee voted unanimously to pass SB 81 out of committee. The measure would establish a Dental Loss Ratio that dental health plans and similar insurers must adhere to. The DLR is a percentage of the total premiums collected by an insurer from policyholders which the insurer must spend on dental care services for patients (following in the same rationale as a medical loss ratio). Under the bill, the minimum DLR for dental benefit plans would be 75 percent for underwritten stand-alone individual dental plans and 83 percent for underwritten stand-alone group dental plans. Among other provisions, the bill also establishes reporting requirements for insurers, inclusive of notating to the state all dental care services and products offered, what the dental loss ratio was for the last reporting period, and aggregate claims paid for dental care services. The bill still has to be placed on special orders for consideration by the full Senate. Its companion measure, HB 212, has yet to receive a hearing in the House.
Colorado
Governor Polis's Budget Proposes Cuts to Medical Education Funding. In his recently proposed budget, Governor Jared Polis (D) included a $50.6 million cut to a program that funds hospitals to pay for the additional costs of training medical residents. Under federal law, prospective payment hospitals that teach residents in a graduate medical education program receive an additional payment for a Medicare discharge known as the Indirect Medical Education (IME) adjustment. The state’s Department of Health Care Policy and Financing proposed reducing the IME rate add-on by 80% for system hospitals. This change is part of several proposals aimed at reducing Medicaid spending in the state, which has risen by almost 60% over the past seven and a half fiscal years, outpacing Colorado’s revenue. The state’s revenue is limited by its Taxpayer Bill of Rights or TABOR, which caps state revenue to the rate of population growth plus inflation, requiring excess revenue to be given back to taxpayers. While the Joint Budget Committee has not yet released its proposed budget, it is expected that the bill will be introduced within the near future, and additional analysis on the proposed cut can be found here when it is up for committee discussion and consideration.
Delaware
Senate Introduces Bill to Cap Healthcare Costs. Last week, Delaware Senate Majority Leader Bryan Townsend (D) introduced SB 1, a bill that would cap cost per service for commercial health benefit plans at 250% of the Medicare reimbursement rate for comparable services, beginning with rate filings in 2028. Notably, the bill includes language that exempts hospitals and other providers from this reimbursement cap if they use a “global budget model” approved by the Department of Insurance. Under these models, hospitals are paid a predetermined amount based on prior year Medicare and Medicaid spending and thus set annual fixed prices for services. So far, Maryland, Vermont, and Pennsylvania have adopted global budget models for different providers in their health systems, while Connecticut, Hawaii, New York, and Rhode Island are set to adopt these models as CMS AHEAD participants. SB 1 also contains provisions that require commercial and state health insurers to spend 11.5% of total medical costs on primary care, eliminate the sunset date on previous cost-containment and primary care spending requirements, and require carriers to offer value-based care programs and allow contractors’ participation.
This bill represents the latest development in the state’s effort to reduce healthcare spending and follows a recent lawsuit over HB 350. Passed in 2024, HB 350 established the Diamond State Hospital Cost Review Board and gave it the power to veto hospital budgets that it deemed excessive. This prompted the state’s largest hospital to sue, and ultimately, the lawsuit was dropped in exchange for the governor enacting SB 213, which removed the review board’s authority to prospectively approve or modify hospital budgets. Looking ahead, SB 1 currently awaits consideration in the Health and Social Services Committee.
Florida
Senate Passes Legislation to Expand Medicaid Work Requirements. Last week, the Senate passed SB 1758, which establishes Medicaid work requirements for eligible individuals aged 19 to 64. Despite interest from the Senate in such work requirements, House Republicans opted to not consider the measure before adjournment. Notably, and something for readers to consider moving forward should other states attempt something similar, SB 1758 would have required individuals to complete 80 hours of work or education each month to maintain eligibility. These requirements come as an additional restriction to the One Big Beautiful Bill Act (OBBBA), which imposed Medicaid work requirements on individuals who received coverage through the Affordable Care Act (ACA). However, Florida is one of ten states that never adopted ACA provisions to expand Medicaid coverage to 138% of the federal poverty level, meaning OBBBA’s requirements do not apply to the state. Last week, Senate Democrats unsuccessfully tried to amend the bill to make the proposed work requirements conditional on the Legislature expanding Medicaid under the ACA.
Maine
State Responds to Federal Medicaid FWA Request for Information. Recently, the Maine Department of Health and Human Services issued a response to the U.S. Department of Health and Human Services (HHS) request for more information regarding eligibility and oversight of Maine’s Medicaid program. In its response, the state defended the program’s existing integrity and compliance mechanisms, and the increase in spending was merely the result of Centers for Medicare & Medicaid Services’ approved requests and to enhance medically necessary services within the state. Notably, Governor Janet Mills (D) weighed in with her own response that suggests HHS may have already made a determination to withhold Medicaid federal matching funds. If that were to happen, Governor Mills indicated she would follow the lead of Minnesota and sue the Trump Administration in response.
Michigan
Package of Bills Concerning Hospital Financial Assistance Programs and Medical Debt Passes House. This past week, the Michigan Senate opted to move a series of measures that intend to set guardrails for certain hospitals as it relates to financial assistance programs and policies and the collection of any medical debt. Having undergone negotiation since the summer of 2025, the following measures were passed this past week and sent to the House for consideration:
SB 449: Requires hospitals as defined within the bill to develop and implement financial assistance programs for patients, if one doesn’t exist already. All programs are required to, among other elements, make the program eligible to any patient who owes the hospital 1 or more unpaid bills in a 12 month period that are greater than 30% of the patients income. The program must also be available to patients with income at or below 350% of the federal poverty level on a sliding scale of up to 100% discount of total billed amount. Transparency and other patient notification requirements are included in the measure.
SB 450: Grants certain rights to boards of hospital trustees relative to determination of patient charity allowances and collection of payments for patient care.
SB 451: Prohibits a consumer reporting agency from including medical debt information in a consumer report and prohibits a collection entity of medical debt from iterating that such information would be included in a consumer report.
SB 701: Requires that any violation of the Medical Debt Protection Act to be considered an unlawful trade practice under the Michigan Consumer Protection Act.
SB 702: Would cap interest and late fees on medical debt from large healthcare facilities and medical debt buyers at 3% annually. The bill also prohibits medical debt creditors and collectors from using extraordinary collection actions, inclusive of property foreclosure or wage garnishment, among other provisions.
As is, it remains unlikely that the package of bills will pass as is by the Republican majority in the House. However, there may be some appetite for a narrowed down package given limited caucus support for such movement.
Minnesota
Governor Walz Announces Proposal to Transform the State’s Human Services System. On Tuesday, Governor Tim Walz (D) announced a plan to overhaul the administration of human services in the state, amidst ongoing scrutiny over Medicaid fraud. The Governor’s proposal includes transitioning from managed care organizations (MCOs) to a single statewide administrative service organization (ASO), shifting the Medicaid eligibility determination process from counties to the state, and dedicating funding for a study to assess recommendations on human services program administration. The proposal was met with opposition from Republicans in the legislature, with Republican House Ways and Means Committee Co-Chair stating, “to put more responsibility on a state agency that acts irresponsibly, to me, is just a very stark, bad idea.”
Mississippi
Legislature Enrolls Measure to Loosen CON Laws for Rural Hospitals. This past week, the Legislature came to an agreement and enrolled HB 1622. The enrolled measure establishes a pilot program that includes 55 rural hospitals across the state and, among that group, would enable them to open one new facility within five miles of their main campuses or make a nonclinical or clinical improvement above Certificate of Need (CON) defined thresholds . Notably, facilities located in the Mississippi Delta will be allowed two exemptions to existing CON laws relative to new facilities. Notably, the bill also includes a provision that intends to speed up the CON process by requiring any party who appeals the state’s approval for a new facility or improvement to pay the applicant’s legal fees if the ruling is not overturned. The bill now heads to the Governor’s desk for signature.
Montana
State Aims to be “Early Adopter” of Medicaid Work Requirements. In a meeting of the Children, Families, Health, and Human Services Interim Committee, the Department of Public Health and Human Services (DPHSS) announced that they are working on a State Plan Amendment to implement Medicaid work requirements, with the plan to go live on July 1, 2026. From July to September, noncompliant renewal and application cases will receive an informational notice/warning and a referral to the HELP-Link Program, but will not be disenrolled. After September, DPHSS will begin disenrolling and denying new applications for noncompliance. Cases with renewals due in November 2026 and May 2027 will be evaluated for CE compliance, and, in the case of noncompliance, the case will proceed to the 30-day cure period and potential disenrollment. During the presentation, DPHSS also stated that they have filled 39 of 59 new staff members to manage the increased workload from H.R. 1 requirements, which is anticipated to cost about $4.3 million for the first year.
Rhode Island
Senate Democrats Release Proposed Healthcare Package. This past week, Senate President Valarie Lawson (D) and Senate Health and Human Services Committee Chairwoman Melissa Murray (D) released their proposed healthcare package for consideration in 2026. The proposed package is inclusive of nine bills that would seek to do the following, among other elements:
Codify funding of the 988 crisis helpline and the Children’s Mobile Response and Stabilization Services (MRSS) program, inclusive of setting a commercial insurance reimbursement floor for MRSS.
Establishment of safety guidelines related to AI and mental health treatment.
Establish additional oversight mechanisms of pharmacy benefit managers (PBMs).
Require insurers to cover a minimum seven days of post-acute care without authorization requirements.
Shifts authority of state vaccination schedules to the state Department of Health.
Establishes a special legislative commission to study medical malpractice claims to healthcare providers.
Invest in loan repayment and scholarship programs to enhance workforce development in the state for physicians, physician assistants, and nurse practitioners.
Establishes a commission to support workforce retention and study the creation of graduate medical education programs (inclusive of the creation of a medical school at the University of Rhode Island).
The Legislature is in session through the end of June. While the package is expected to receive considerable attention and have support by Senate Democrats, its fate in the House remains up for consideration.
Tennessee
Finance, Ways, and Means Subcommittee Holds Hearing on Certificate of Need Bill. On Wednesday, the Senate Finance, Ways, and Means Subcommittee held a hearing on HB 819, which eliminates certificate-of-need (CON) requirements for acute care hospitals. During the hearing, the Subcommittee agreed to an amendment that also removed CON requirements for satellite emergency departments and cardiac catheterization by July 1, 2027, and extended the effective date for the dissolution of the acute care requirement from July 1, 2028, to 2030. The bill is scheduled for further subcommittee consideration on Wednesday, March 18th.
Virginia
House and Senate Pass Alternative to PDAB Bills. This past week, the legislature made significant amendments to Prescription Drug Affordability Board (PDAB) bills HB 483 and SB 271. Instead of creating a PDAB with upper payment limit (UPL) authority, the substituted bills now create a Prescription Drug Affordability Advisory Panel tasked with conducting data analyses, developing policy recommendations, and identifying implementation barriers related to strategies to improve prescription drug affordability, price transparency, and data collection practices. The legislation contains several other provisions related to drug pricing, reimbursements, and price transparency, including provisions that:
Prohibit drug manufacturers and wholesalers from charging more than MFP for the sale of a prescription drug subject to MFP intended for use by individuals in the Commonwealth in person, by mail, or by any other means, plus any applicable pharmacy dispensing fees and provider administration fees.
Prohibit a pharmacy from being reimbursed for a referenced drug at an amount less than the MFP or the national acquisition cost, whichever is greater.
Require pharmacy benefit managers (PBMs) to provide pricing and payment data to the Advisory Panel.
Direct health plans to use any savings from MFP to reduce consumer costs.
Establish financial penalties for manufacturers that withdraw a drug to avoid rate limitations.
SB 271 passed the House with a substitute, and the Senate agreed to the substitute today, sending the legislation to Governor Abigail Spanberger (D).
Wyoming
Governor Gordon Signs Abortion Ban Into Law. On Monday, Governor Mark Gordon (R) signed HB 126 into law, finalizing the legislature's recent attempt to ban abortion in the state. HB 126 followed the state’s supreme court ruling earlier this year that struck down the state’s existing near-total abortion ban. As enacted, HB 126 prohibits abortions if a fetal heartbeat is detected, which is typically around 6 weeks of gestation. The bill allows for an exception for a medical emergency necessary to prevent the impairment or death of a pregnant person. In his signing letter, Governor Gordon expressed support for protecting the lives of the unborn, but noted that it is not a “durable solution” as the bill will likely result in litigation. He also reiterated the need for a constitutional amendment to address the issue.
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.
