Weekly StateVitals Update: Volume 62 (March 30, 2026)

Colorado

• Committee Approves Bill to Require Business to Help Fund Medicaid. On Wednesday of last week, the House Health & Human Services Committee approved HB 1327 to create the large employer health-care support enterprise to impose an annual fee on an employer with 500 or more workers receiving state Medicaid benefits. The bill assesses a fee of $2,300 per such worker and directs revenue from the fee to fund Medicaid benefits and increase reimbursement rates for Medicaid providers. The bill’s fiscal note estimated that the fee would bring in about $85 million of revenue in FY2028 and that at least 37,200 Medicaid enrollees are employed by businesses that would be subject to the proposed fee. House Democrats contend that the bill is necessary to address the state’s projected budget deficit and address rising Medicaid costs, particularly as federal policy changes under H.R. 1 come into effect. The bill's sponsor, Representative Lisa Feret (D), stated that “Colorado taxpayers should not subsidize the nation’s largest corporations by way of our state providing Medicaid for their employees.” The bill passed the committee on an 8-5 party-line vote and is now in the House Finance Committee.  

Idaho

• Senate Enrolls Bill Cutting Medicaid Disability Services by $21.8 million. On Tuesday of last week, the Senate enrolled HB 863 on a 19-15 vote. If enacted, the bill would cut Medicaid reimbursement rates for residential habilitation services by $21.8 million next fiscal year. The cuts themselves were recommended by Governor Brad Little (R). Notably, the cuts come by reducing pay raises for providers; raises that the Legislature originally approved in 2022. However, these raises were intended to expand services and to use a new budget tool, which was ultimately blocked by a court order in the KW v. Armstrong lawsuit. Including the Medicaid rate cuts from last year, these cuts would result in a 10% reduction in the reimbursement rate for residential habilitation providers.  But legislators supporting the bill state that providers would still have reimbursement rates 33% higher than they were four years ago. HB 683 is now headed to Gov. Little’s desk for signature. Once received, he has 5 days to either sign it into law, allow it to become law without his signature, or veto it.

• Idaho House Passes Medicaid Work Requirements. This past week, the Idaho House passed HB 913 by a 59 to 9 vote. The measure requires the state to implement Medicaid work requirements as outlined in the One Big Beautiful Bill Act passed by Congress last summer. Notably, the bill requires that no later than December 31, 2026, the state is required to implement work requirements as outlined in federal statute. The bill also establishes conditions for Medicaid expansion enrollment to adhere to work requirements. Notably, it prohibits individuals from enrolling in the Medicaid expansion program unless that individual demonstrates compliance with work requirements for three consecutive months immediately preceding the month during which the person applies for eligibility. The measure also authorizes the state to disenroll any individual from Medicaid that is currently enrolled who is unable to demonstrate compliance with those requirements. The bill now heads to the Senate for consideration. 

Illinois

• PDAB Measure Passes First Committee Vote in House. This past week, the House Health Care Availability and Access Committee voted by an 8 to 4 margin to advance HB 1443. The bill establishes a Health Care Availability and Access Board with the authority to review the affordability of prescription drugs and set a maximum price if the Board finds that the drug presents affordability challenges. Notably, the Illinois Departments of Central Management Services and Healthcare and Family Services are both opposed to the measure citing its unknown impact on Medicaid rebates and a lack of protection for those rebates as part of the effort. Other lawmakers during the Committee hearing this past week raised concerns about accountability for the Board. As part of the hearing process, Rep. Nabeela Syed (D), the sponsor, has iterated a commitment to retain upper payment limit authority as part of the bill if it proceeds. 

Iowa

• Senate Enrolls Bill Raising Taxes on HMO Health Insurance Plans. This past Tuesday, the Senate voted 26 to 19 to enroll HF 2739, which would replace the current premium tax on health maintenance organizations (HMOs) with a new tax on the organizations’ taxable funds. The new tax would be set at 3.5% for the 9 months of 2026 and 0.95% thereafter. Republican lawmakers supporting the bill say the tax is necessary to cover the state’s Medicaid budget deficit. Democratic legislators warn that HMOs will pass the tax cost onto consumers through higher premiums. The bill now heads to Governor Kim Reynolds (R), who will have three days to either sign the bill, let it become law without her signature, or veto it.

• House Enrolls Medical Conscience Bill. Last week, the House enrolled HF 571 in a 63-27 vote, sending the bill to Governor Kim Reynolds (R). As enrolled, the bill would allow medical practitioners and health care institutions, such as hospitals and clinics, to refuse to participate in or pay for services that violate their conscience, with exceptions for emergency medical services. HF 571 also prohibits discrimination against these parties from refusing services and grants them immunity from civil, criminal, or administrative liability if their denial is based on their “ethical, moral, religious beliefs or principles.” Furthermore, the bill creates whistleblower and free speech protections for practitioners. Recent amendments removed language that included health care payors, or health insurance providers, from the bill. Supporters like Representative Bill Gustoff, R-Des Moines, see the bill as a way to address Iowa’s current health care workforce shortage, while other legislators, such as Representative Austin Baeth, D-Des Moines, are glad that payors were removed from the bill but are still concerned that the bill could allow medical providers to discriminate against patients. Once the bill arrives, Gov. Reynolds will have three days to act.

Kansas

• Legislature Enrolls PBM Dispensing and Transparency Bill. This past week, both the Kansas House (104-17) and Senate (32-8) enrolled an amended version of SB 20, which now includes regulations on Pharmacy Benefit Managers (PBMs) adopted through a conference committee meeting on Monday of last week. As enrolled, the SB 20 requires PBMs to pay pharmacists a $10.50 dispensing fee and to disclose the rebates they receive and how they are paid out. Kansas is not the only state to impose dispensing fees on PBMs; Arkansas and West Virginia have enacted similar measures in recent years. The bill now heads to Governor Laura Kelly’s (D) desk, who will have 10 days to act once presented to her.

Mississippi

• Governor Reeves Enacts Law Loosening CON Requirements for Rural Hospitals. On Monday of last week, Governor Tate Reeves (R) signed HB 1622 into law, which creates a pilot program benefiting 55 rural hospitals across the state that face loosened certificate-of-need (CON) requirements. Specifically, hospitals in small communities may open a new facility within 5 miles of their main campuses or make a nonclinical or clinical improvement above Certificate of Need (CON) defined thresholds. Notably, facilities located above the Mississippi Delta face even looser CON requirements and will be allowed two exemptions. HB 1622 contains additional provisions that allow facilities to open geriatric psychiatric units without seeking approval and require parties who appeal the state’s approval of a new facility or improvement to pay the applicant’s legal fees if the ruling is affirmed. The law became effective on signature, and the program will continue through June 2027. Zooming out, it’s possible that Mississippi’s modified CON laws could help the state secure additional funding under the Rural Health Transformation Program in the next few years. Half of the program’s funding is allocated using a formula that considers a state’s rurality, the quality of its application, and alignment with Make America Health Again policies, such as CON reform. 

Missouri

• Senate Passes Measure Establishing Framework for Involuntary Community-Based Mental Health Treatment. This past week, the Missouri Senate advanced SB 1015 which would establish a process for physicians, legal guardians and public health directors to petition courts to order up to two years of outpatient treatment for individuals with serious mental illness who are unwilling to seek care voluntarily. The outpatient care would allow such an individual to seek care in their community prior to being hospitalized or incarcerated. Beyond the request from the medical community for action, an influential part of the conversation has been the expected savings Missouri would realize from the pivot, which similar savings arising in Kentucky resulted in net savings of $1,326 per outpatient participant. The bill now heads to the House for consideration. 

Nebraska

• Nebraska Seeks to Limit Retroactive Medicaid Eligibility. Recently, the state’s Department of Health and Human Services (DHHS) announced its intent to submit an application for approval of a five-year Section 1115 waiver to limit Medicaid eligibility for the full Medicaid population. Under current law, Medicaid retroactively pays for three months of care before a Medicaid-eligible patient submits an application for coverage. As it stands, 10 other states (AZ, AR, FL, IN, IA, MA, NH, OK, TN, and UT) have limited retroactive coverage; although these states have exempted some groups from the limited coverage or have a longer coverage period than Nebraska’s universal proposal. The public comment period for the state ended this past week, and it’s expected that the waiver application will be submitted in the coming month or so to the Centers for Medicare & Medicaid Services. 

Oregon

• PDAB Approves 2025 Drug Review Report and Identifies Subset List for 2026 Review. During its March meeting, the Oregon Prescription Drug Affordability Board (PDAB) approved its 2025 Drug Review Report, which identified Cosentyx, Trulicity, Vraylar, and Lantus SoloStar as products that may create affordability challenges due to a combination of utilization, system-level spending, continued price growth, and patient cost exposure. The PDAB, which does not have upper payment limit authority, also approved policy recommendations for out-of-pocket caps and point-of-sale rebate pass-through as part of the report. During the meeting, the PDAB also selected a subset list of drugs to review in 2026, which includes Ocrevus, Tremfya, Skyrizi, Xolair, Keytruda, Verzenio, Xeljanz, Jardiance, Mounjaro, Ozempic, Humulin R U-500, and Humulin R U-500 Kwikpen. The PDAB will now collect additional data and feedback on the selected drugs before starting reviews in June. 

Oklahoma

• House Adopts Measures to Send Medicaid Expansion Questions Back to Ballot. Last week, the House of Representatives passed HB 4440, which would put a question back on the ballot for voters asking them to remove Medicaid expansion from the state’s constitution and instead have program authorization placed in statute. The measure was sponsored by Speaker Kyle Hilbert (R), with the Speaker iterating that flexibility is needed by the Legislature to adjust the Medicaid program when possible to accommodate for increased costs. Notably, the measure calls for the question to be placed on the ballot during a special election happening on August 25, 2026. Additionally, the House also passed House Joint Resolution 1067, which would send another ballot question to voters related to Medicaid expansion. It would allow the Legislature to end Medicaid expansion coverage if the federal match were to ever drop below a 90 percent rate. Similarly, the measure would call for the question to be placed on a ballot during a special election on August 25, 2026. 

West Virginia

• WV Rural Health Transformation Program launches public listserv for updates and events. The West Virginia Department of Health has launched an informational listserv to keep the public up to date on upcoming requests, events, and other relevant updates related to the Rural Health Transformation Program.  Those who would like to receive email updates can subscribe by visiting the RHTP Listserv page at the WV Department of Health. This follows a webinar hosted by Governor Patrick Morrisey last week, which focused on how the state intends to operate the RHTP and timelines for grant awards and reporting compliance. 

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