Weekly StateVitals Update: Volume 69 (May 18, 2026)

National

• Supreme Court Overrides Ban on Mail-Order Abortion Medication Access. This past week, the U.S. Supreme Court issued an order that continued to block a ruling by the 5th Circuit and found that mifepristone may remain accessible via telehealth and mail for the time being. The decision followed a previous extension of an administrative stay on the 5th Circuit’s ruling that had paused mail order availability for mifepristone. The new order will allow mifepristone to remain accessible via telehealth and mail as litigation continues in the lower courts. The order was issued on a 7-2 decision, with Justice Thomas and Justice Alito dissenting, arguing that pharmaceutical companies cannot be irreparably harmed as suggested in the emergency appeal if a court order makes it more difficult for them to “commit crimes.”

Arizona

• AHCCCS to Utilize AI for Prepayment Claim Review. Recently, the Arizona Health Care Cost Containment System (AHCCCS) announced their intent to start using artificial intelligence to review payments to providers in an effort to prevent fraud, waste and abuse (FWA). In a letter from Governor Katie Hobbs (D) to the Center for Medicare & Medicaid Services, it was noted that the state will launch the AI-informed Medicaid prepayment review system which will rank claims by their risk of FWA before a payment is made. A human will review the highest-risk claims, while compliant providers are expected to see quicker payment approval. While the initiative within AHCCCS has been in development for months, the announcement comes in response to a previous April CMS directive asking all states to revalidate “high-risk providers” in their Medicaid programs.

Colorado

• Colorado Governor Signs FY2027 Budget with Medicaid Reductions. This past week, Governor Polis (D) signed the state’s FY2027 budget. From a high-level perspective, the budget includes $270 million in reductions to Medicaid reimbursement rates and services. Notably, it includes a limit on reimbursements to family members who serve as caregivers of Medicaid recipients. Starting in 2027, caregivers will only be reimbursed for 56 hours per week ($80,000 annually). Most states currently reimburse up to 10 hours per week. Additionally, it made significant adjustments to the Cover All Coloradans, which is a program extending coverage to children and pregnant women ineligible for Medicaid due to their immigration status but would otherwise be eligible. Of those changes, the legislature capped enrollment at  25,000 children annually and reduced the eligibility cutoff from 19 to 18. Additionally, the bill would cap dental benefits for beneficiaries at $1,100. 

Delaware

• Governor Announces Introduction of Two Bills to Lower Healthcare Costs. Governor Matt Meyer (D) announced last week his office has worked to and supported the introduction of SB 13 and SB 313. SB 13 would establish comprehensive statewide standards for hospital charity care. It would require all general acute care hospitals in Delaware to provide free care to individuals up to 300% of the Federal Poverty Level (FPL) and discounted care up to 400% of the FPL, regardless of insurance status. Hospitals would also be required to maintain a medical hardship policy providing at least a 50% discount for patients with expenses greater than 10% of their household income if they are below 500% of the FPL. Finally, the measure also requires physicians that work in hospital settings but are not employed by the hospital to honor financial assistance determinations on their own billing practices if the services were rendered in the hospital based setting. 

  SB 313 would prohibit any for-profit entity from acquiring control of a nonprofit acute care hospital in the state. The bill also bars for profit entities from submitting Certificate of Public Review applications to develop, construct or acquire acute care hospitals in the state. Both of those provisions are subject to a sunset date of July 1, 2028. Delaware still has until a June 30, 2026 adjournment date to move legislation. 

Georgia

• Dept. of Community Health Issues Medicaid FWA RFI. This past week, the Georgia Department of Community Health issued a Request for Information (RFI) for a Medicaid fraud, waste, and abuse (FWA) detection and prevention solution. The intent would be for the service to monitor activity across the state’s fee-for-service and managed care programs. Notably, the RFI wants input from stakeholders and vendors on the types of services and tools utilized that integrate AI, cloud-based analytics, and a high level of program integrity expertise in identifying billing concerns, providing payment review support, and verifying member residency and eligibility, among other elements. The intent is that the RFI will inform future procurement. 

Indiana

• Supreme Court Denies Petition to Hear Challenge to Abortion Ban.  This past week, the Indiana Supreme Court denied Planned Parenthood's petition to have its challenge heard in objection to the state’s near-total abortion ban. Filed by the Supreme Court on Thursday, the order brings to an end the specific case in hand following the Indiana Court of Appeals’ decision to uphold the state’s abortion ban in August 2025. Planned Parenthood and other abortion providers had originally filed suit in 2024, arguing that the three part exception provided in statute in the aftermath of the overturning of Roe v. Wade in June 2022 was vague and narrow, making it difficult for providers at hospital-based settings to perform an abortion. Despite the result of this specific case, the Indiana Supreme Court is set to preside over a separate case to determine the state’s ability to enforce a near total abortion ban specific to individuals requesting a religious exemption in the near future.

Iowa

• Governor Signs Prior Authorization Reform Bill into Law. This past week, Governor Kim Reynolds (R) signed HF 2635 into law. The new law prohibits health insurers from using artificial intelligence to determine whether to deny prior authorization requests. The measure also exempts certain cancer screenings from prior authorization requirements and will prevent insurers from penalizing physicians who refer patients to out-of-network providers, among other provisions. The measure had received unanimous support in both the Senate and the House before being enrolled and sent to the Governor. 

Minnesota

• Senate Disagrees With House-Engrossed Medicaid Reform Bill. Last Monday, the House passed SF 4612, returning the omnibus bill to the Senate to concur with the amendments before enrolling the bill. The Senate refused, sending SF 4612 to a conference committee for further discussion. As engrossed by the House, SF 4612 would:

  • Establish Medicaid work or community engagement requirements.

  • Establish a Medicaid pharmacy dispensing payment of $2.25 per prescription filled, in addition to other dispensing fees paid by the commissioner to the pharmacy. 

  • Requires that the final reimbursement to a pharmacy from managed care and county-based purchasing plans and any pharmacy benefit managers under contract with these entities be at least a dispensing fee of $11.55 per claim for prescriptions filled with drugs meeting the definition of covered outpatient drugs. 

  • Provides for employee retention and protection during a healthcare transaction. 

  • Requires health plans to cover diagnosis and treatment of infertility and standard fertility preservation services at comparable cost-sharing to other healthcare services.

  As of last Tuesday, the House and Senate have selected their committee members, though no meeting date has been set.

Missouri

• Comprehensive Healthcare Bill Heads to the Governor’s Desk. As the Missouri General Assembly wrapped up its work this past week, the House and Senate enrolled HB 2372. The measure provides for numerous reforms to affordability and maternal health issues among the state, with some issues having been negotiated for the past four years. Key elements of the bill include: 

  • Requires insurers to provide authorization for an annual supply of contraceptives for women rather than requiring more frequent prior authorization approval. 

  • Requires insurers to cover blood pressure monitoring equipment for pregnant and postpartum mothers. 

  • Establishes protections for 340B covered entities, inclusive of anti-discrimination contracting or reimbursement policies by insurers or PBMs.

  The bill now heads to Governor Kehoe (R) for consideration and his signature. 

New Hampshire

• House Committee Opts to Sit on Insurer Assessment Bill. Recently, the House Commerce and Consumer Affairs Committee opted to recommend sending SB 498 to an interim study. The measure would establish the New Hampshire Children’s Behavioral Health Association, with the express intent to collect assessments from insurance carriers, third-party administrators, and stop loss carriers. The funds raised would be intended to render behavioral health services for individuals 18 years or younger. The bill would have also required insurers’ mental health parity comparative analyses to include specific data by age group and other factors, such as denial rates and network capacity, to better inform barriers to care. Governor Kelly Ayotte (R) iterated her concern with the committee’s decision, noting that some insurers are stalling on this bill because they don’t want to have to cover mental health coverage for children. Insurers have argued that the assessment will force them to increase premiums. The Committee’s vote on the bill to send it to an interim study is only a recommendation for the time being.  It will still go before a vote of the full House, which does not require the full House to adhere to the Committee’s recommendation. 

Rhode Island

• Attorney General Announces a Series of Healthcare Legislation. Recently, Attorney General Peter Neronha (D) announced several pieces of healthcare reform legislation he is advocating for. The legislation includes:

  • HB 8360 & SB 3260: Prohibits pharmacy benefit managers (PBMs) from engaging in spread pricing, steering patients, or having their owned mail-order pharmacies repackaging drugs to increase the price without notifying enrollees. It also requires PBMs to honor completed step therapy and prohibits early-refill restrictions on maintenance medications.

  • HB 8382 & SB 3258: Expands pharmacy audit regulations to all audits, as well as limits exemptions for fraud, waste, and abuse audits, and tightens their scope. The bill also requires advanced notice to the attorney general before initiating an exemption-based audit.

  • HB 8383 & SB 3257: Creates a voluntary state-wide prescription drug purchasing pool, authorizes the director of the pool to enter multistate purchasing agreements and negotiate PBM contracts, and permits the director to offer stop-loss insurance coverage to pool participants. 

  • HB 8364 & SB 3244: which authorizes the attorney general or the department of health to petition a court to place a hospital into receivership on specified grounds, including mismanagement, insolvency, wasted assets, or operations that are detrimental to patient health. It also grants the court and appointed receiver the authority to liquidate assets, continue hospital operations, and pay the hospital's liabilities.

  As per typical session procedures, all the House bills have been heard and held for further study, while the Senate bills are still awaiting hearings. The Attorney General is hoping to pass the legislation before the legislature adjourns on June 30th.  

Virginia

• Governor Signs Package to Cap Insulin and Lower Prescription Drug Costs. This past week, Governor Abigail Spanberger (D) signed a package of bills intended to lower prescription drugs costs, inclusive of capping insulin out of pocket costs. The bills are part of a broader package that the Governor has worked on with General Assembly leadership this past session, billed as the Affordable Virginia Agenda. The bills include: 

  • HB 1214: Caps out-of-pocket costs for a 30 day supply of insulin at $35 for state-regulated plans. 

  • HB 625 & SB 161: Requires Marketplace health insurers to offer plans that cap monthly out-of-pocket prescription drug costs. 

  • HB 736: Prohibits insurers from amending a prior authorization approval for the duration of a granted authorization, which may be the minimum of six months for initial authorizations or a minimum of 12 months for continued authorizations. 

  • HB 328: Expands the essential health benefits benchmark plan to include coverage for doula care, infertility treatment, hearing aids and other services. 

  • HB 484 & SB 164: Establishes limitations on health insurers from downcoding claims. Requires the insurer who does downcode a claim to provide notice to a provider and requires that all downcoding disputes are reviewed and adjudicated by a person. 

West Virginia

• Governor Morrisey Announces Additional RHTP Funding. Recently, Governor Patrick Morrisey (R) announced that applications for the $29.5 million Provider Productivity Support Fund (PPSF) were now open. The fund is part of an initiative to improve healthcare access and support healthcare providers’ administrative and operational demands. The funding comes as part of the Smart Care Catalyst (SCC) pillar of the state’s Rural Health Transformation Program (RHTP), which now totals to $58 million in available funding opportunities. Under SCC, there are two types of funding, one to improve provider productivity and efficiency, and one to support shared-service models and multi-provider collaboration. Interested providers may apply to both funding types through the state portal.