Weekly StateVitals Update: Volume 65 (April 20, 2026)
Florida
State Opens Applications for Rural Health Transformation Program Grants. Last Tuesday, the Agency for Health Care Administration (AHCA) released the first round of grant applications under the state’s Rural Health Transformation Program (RHTP). The state was awarded $209 million for the first year of funding, and the grant opportunities focus on infrastructure to monitor program success and track deliverables and expenditures. The state specified grant opportunities for applicants who can provide services within four areas:
Grant management technology.
Evaluation services to monitor compliance, data governance, and efficacy of an initiative.
Technical assistance services for grant sub-awardees.
Education and outreach services to assist Medicare and Medicaid beneficiaries who select an integrated health plan.
In the announcement, AHCA also noted that it would be releasing a second round of funding opportunities soon. Notably, AHCA’s announcement comes right before the Joint Legislative Budget Committee is expected to authorize the agency to spend the RHTP funding. Looking ahead, the agency must award both rounds of grants by Sept. 30 2026, and the funds must be spent by Sept. 30, 2027.
Idaho
Governor Little Signs Medicaid Work Requirements Bill. Governor Brad Little (R) recently signed HB 913, which implements Medicaid work requirements as outlined in the One Big Beautiful Bill Act (OB3) passed by Congress last summer. The act is effective immediately and requires the state to implement the work and community engagement requirements outlined by December 31, 2026. Notably, enrollees who are covered under the state’s 2018 Medicaid expansion are required to prove work history for three months before they apply to Medicaid, which is the longest review period permitted under federal statute. Zooming out, this makes Idaho the 6th state to enact Medicaid work requirement legislation this session, along with Indiana, Nebraska, New Hampshire, Utah, and Wyoming.
Iowa
Bill Restricting Mail-Order Abortion Medication Advances in House. This past Tuesday, members of the House Appropriations subcommittee met to discuss HF 2563, a bill that would restrict patients’ access to mifepristone and misoprostol. The subcommittee voted 2-1 to advance the bill with an amendment that removes provisions requiring physicians to tell patients it is possible to reverse a medical abortion, a claim contested by major medical organizations as misinformation. The bill would prohibit the dispensing of abortion medications unless they are provided directly to patients in a healthcare setting, creating a private cause of action for violations and effectively eliminating mail-order dispensing. Additionally, the legislation would require physicians who provide medication abortion to obtain written confirmation that they provided patients with information on risks, follow-up recommendations, and the possibility of trauma. The bill now heads to a full Appropriations Committee meeting, before the legislature convenes on Wednesday, April 21.
House Enrolls Bill to Expand Subacute Mental Health Services. Last Monday, the Iowa House enrolled HF 2543, which would expand subacute mental health treatment for patients. Under current state rules, insurance companies are able to limit coverage of subacute care to 10 days. This bill would eliminate any rules authorizing this limit. Additionally, the legislation would establish an electronic bed tracking system to track the availability of beds at psychiatric medical facilities for children. Notably, the original version of the bill prohibited prior authorization for the first 15 days of care and limited managed care organizations' authority over medical necessity rules and patient discharges. However, these provisions were amended out of the final version that is now headed to Governor Kim Reynolds’ (R) desk for signature.
Maryland
Prescription Drug Affordability Board Votes to Set Upper Payment Limit on Jardiance. This past Monday, the Maryland Prescription Drug Affordability Board (PDAB) voted to finalize cost review study reports for two diabetes drugs, Farxiga and Jardiance. The PDAB made a final determination that both drugs have led or will lead to an affordability challenge, but only voted to proceed with setting an upper payment limit (UPL) for Jardiance. The PDAB opted not to set a UPL for Farxiga because the drug will soon have generic versions available. The PDAB approved proposed regulations to set the UPL for Jardiance at the Medicare maximum fair price for state and local government health plans in 2027. The proposed regulations will now go through the rulemaking process, which includes a 30-day public comment period, before the PDAB takes a final vote. The PDAB is also conducting cost review studies on Ozempic, Trulicity, Skyrizi, and Dupixent. In addition to the UPL, the PDAB also approved non-UPL policies to address drivers of the affordability challenges for Jardiance, including wholesale acquisition cost inflation penalties, patient navigator program, and PBM reimbursement reform.
Missouri
Emergency Contraception Bill Passes House Crime and Public Safety Committee. Recently, the House Committee on Crime and Public Safety voted 11-4 to pass HB 3434. The bill would require hospitals and health care facilities that provide emergency care to sexual assault victims to provide emergency contraception upon request. Additionally, these entities would be required to inform the patients of options for emergency contraception and provide sexually transmitted infection screening and treatment. The bill specifies that the Missouri Department of Public Safety will cover the costs of providing the patients with emergency contraception and related medical treatment. With the committee passing HB 3434, it is now expected to be placed on the perfection calendar, where it will be debated on the House floor, before a third reading.
Nevada
Governor Lombardo Implements Hospital Price Transparency Law. Recently, Governor Joe Lombardo (R) launched the Nevada Hospital Price Price Finder, which allows people to compare the price of health care services across the state. The online price finder comes as a result of the Hospital Transparency Act AB 343, which was enacted last year. AB 343 introduced new hospital price transparency requirements for the across the state, requiring hospitals to compile, publish, and update annually a list of shoppable services and standard charges for all items and services provided by the hospital. Now, consumers are able to access pricing for 300 shoppable procedures through the portal. In particular, the price finder includes the exact negotiated rates for procedures and not estimated costs. Additionally, under the Act, hospitals cannot collect medical debt if they are noncompliant with transparency requirements and the Nevada Department of Health and Human Services may monitor and penalize facilities who do not update their pricing data.
Oregon
Federal Judge Rules that Law Requiring Insurance Coverage of Abortions and Contraception is Unconstitutional. Last Tuesday, District Court Judge Mustafa Kasubhai issued a temporary ruling that Oregon’s Reproductive Health Equity Act, requiring insurance coverage, without cost-sharing, for abortions and contraception, violates the Constitutional rights of the pro-life nonprofit, Oregon Right to Life. Notably, the law provides employers with religious exemptions from the mandated coverage, which led Oregon Right to Life to sue in 2023. While the nonprofit acknowledged it did not qualify for a religious exemption under the 2017 law, it argued it should be allowed one and that the law violated its First Amendment rights. The lawsuit was then dismissed by a different District Court in September 2024, a ruling which the Ninth Circuit Court later reversed in October 2025. Judge Kasubhai has not yet issued a final ruling specifying the impact of this case, which is expected to arrive at some point in the next several weeks. In the meantime, Governor Tina Kotek (D) specified in a statement that “the law is still in effect, and the judge has not issued and injunction barring the State from applying or enforcing this ruling.”
Oklahoma
Senate Enrolls Bill to Move Medicaid Expansion From Constitution to Statute. This past Thursday, the Senate enrolled HB 4440, which would order a legislative referendum to remove Medicaid expansion language from the Oklahoma State Constitution and place it in statute instead. This would make it easier for legislators to change the state’s Medicaid expansion requirements, which Oklahomans voted to place in the state’s constitution in 2020. Notably, the bill previously had provisions to include a vote to approve Medicaid work requirements on August 26, 2026, though these were amended out last month by the House. As it stands, the bill is headed back to the House to review the latest amendments before being sent for Governor Keven Stitt’s (R) signature.
Tennessee
House Enrolls Bill Removing CON Requirements for Acute Care Hospitals. Last Monday, the House of Representatives enrolled SB 1369, which would remove certificate of need (CON) requirements for acute care hospitals. Additionally, the legislation contains provisions removing the CON requirements for opening a satellite emergency department or providing cardiac catheterization services, as well as authorizing the Health Facilities Commission to license acute care hospitals. Notably, the State’s repeal of its CON laws follows its Rural Health Transformation Program (RHTP) application for which the State received $206.9 million in the first year of funding. CMS incentivized states to remove certain CON requirements by including such action as incentive-based criteria for scoring RHTP applications. Last Wednesday, the Senate concurred with the recent House Amendments. In the coming weeks, it is expected an identical version of the bill will be printed and signed by the Senate and House President before being sent to Governor Bill Lee’s (R) desk for signature.
Senate Concurs with Amendments to Enrolled Bill Setting Expiration Date on Hospital System’s COPA. This past Wednesday, the Senate concurred with the House amendments on the recently enrolled SB 2414, which would allow a Certificate of Public Advantage (COPA) for Ballad Health to expire in June 2028, ending Tennessee’s regulatory oversight of the system. Notably, two weeks ago, Directors of the Federal Trade Commission’s (FTC’s) Office of Policy Planning and Bureau of Competition and Economics issued a letter to Representative David Hawk (R - 5th District) warning of potential anticompetitive consequences if the COPA expired. Specifically, the FTC stated that by eliminating the COPA, the Tennessee Department of Health would no longer have supervision over Ballad Health’s service quality, availability of care, access to care, or population health initiatives. Additionally, the FTC clarified that while it generally recommends that state lawmakers not enact new COPA laws, repealing an existing law or allowing a COPA to expire without a competing healthcare system would enable a monopolist to exercise substantial market power. These consequences, the FTC advises, could lead patients to face higher healthcare costs and lower-quality care. Looking ahead, the bill will now be prepared in a final identical version for the House and Senate President to sign before sending to Governor Bill Lee (R) for signature.
Virginia
Governor Spanberger Issues Amendments to Prescription Drug Affordability Advisory Panel Bill. This past Monday, Governor Abigail Spanberger (D) issued her amendments for Virginia’s Prescription Drug Affordability Advisory Panel bills SB 271/HB 483. Notably, Spanberger’s amendments contain a clause delaying the effectiveness of the Medicare Maximum Fair Price (MFP) controls unless the 2027 General Assembly decides to reenact the provisions. This amendment would impact the following provisions related to drug pricing, reimbursements, and price transparency:
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.
As amended, the bills still create a Prescription Drug Affordability Advisory Panel and now also direct the Panel to submit a report on legal implications, operational recommendations, and evidence of effectiveness related to the MFP provisions. Bill sponsor, Senator Creigh Deeds (D-District 11), has indicated he does not support the Governor’s amendments. The General Assembly is set to reconvene on April 22 and 23 to review the amendments, challenge vetoes, and finalize the state budget, where they may decide to return the bills to Spanberger without her enacting clause amendment.
