Weekly StateVitals Update: Volume 7 (February 17, 2025)
National
NASHP releases updated hospital cost tool. The National Academy of State Health Policy (NASHP) has released an update to its frequently cited Hospital Cost Tool. NASHP intends the dashboard to assist state lawmakers and staff with driving insights into how much hospitals spend on care services, how those costs compare to what the hospital charges, and the actual prices that are paid by health plans. The update in this latest edition for lawmakers includes data visualizations using Tableau and data splicing to view single health system views of available data.
Arkansas
Senate committee votes down repeal of fluoride requirement in water. This past week, the Arkansas Senate Committee on Health, Welfare and Labor opted to vote against recommending passage of SB 2 coming up one vote short. The measure would repeal an existing state requirement that mandates any entity that owns or controls a public water system to control and maintain the quantity of fluoride in the water at a level established by the state. During the hearing, Delta Dental of Arkansas and the Arkansas chapter of the American Academy of Pediatrics spoke in opposition to the measure while the Arkansas Rural Water Association and Ozark Mountain Regional Public Water Authority spoke in favor of the measure. It’s unlikely to receive further consideration this year with another similar measure, SB 4, being deferred in a separate committee.
Colorado
House passes measure to enhance coverage for mental health care. Last week, the Colorado House passed HB25-1002 by a 54-9 vote. The measure would provide for standardized utilization review criteria for the treatment of behavioral and mental health disorders that would align with utilization review and determinations made of physical health treatment. Specifically, the bill requires use of criteria and guidelines as published in a most recent version of criteria developed by an unaffiliated nationally recognized non-profit clinical specialty associations of relevant behavioral or mental health disorders. Apart from standardized utilization review criteria, the measure would also codify requirements pertaining to coverage parity of the federal Mental Health Parity and Addiction Equity Act into state law. The measure now heads to the Senate for consideration.
Georgia
Senate advances measure to prohibit public funding for adult gender affirming care. This last week, the Senate voted by a 33-19 margin to pass SB 39. The measure would prohibit any state public dollars from being used for gender affirming care as part of the state employee and state university employee health plans, in Medicaid, or within the corrections system. This prohibition would apply to any of these health plans or Medicaid rendering coverage to both minors and adults. The state had previously adopted legislation in 2023 that prohibited gender affirming surgeries and hormone replacement therapies for individuals under the age of 18, yet allowed physicians to continue prescribing puberty blockers and allow minors who at the time receiving hormone replacement therapies to continue to do so. The measure now heads to the House for consideration.
Idaho
Idaho House Committee advances measure to repeal Medicaid expansion. The Idaho House Health and Welfare Committee voted last week to advance HB 138 out of committee and to the full chamber for consideration. Sponsored by Rep. Jordan Redman (R-Coeur d’Alene), the measure would create a poison pill that would prohibit the state from extending eligibility to the expansion population if federal financial participation were to ever be less than 90 percent. Additionally, the measure would implement work requirements for all able-bodied adults enrolled in the expansion program. For compliance, it would require enrollees to work twenty hours or more per week averaged monthly or meet other qualifying activity (inclusive of volunteering, a work program, or meets one of eight exemptions). The bill would further cap enrollment in the expansion program to the lower of 50,000 enrollees or a total represented by the total number of adults enrolled in Medicaid that are disabled or over 65 years of age, whichever is less. Additionally, the measure implements a lifetime benefit limit of 36 months for individuals enrolled in the expansion eligible category.
Given that most of these measures are predicated on federal approval, it’s unclear whether some of the provisions would be able to be implemented which would then, under the bill, require a repeal of the Medicaid expansion program. Some of the proposed provisions, such as the lifetime benefit limit, have never been proposed or considered by a federal Administration before. The measure was voted out of committee by a slim 8-7 count and its fate on the House floor is unknown.
Indiana
House Committee advances Medicaid HCBS waiver diversion measure. The House Committee on Public Health passed HB 1391 this last week. The measure would establish the Medicaid Diversion Pilot Program, which would allow the state to leverage home and community-based services made available through the state’s Area Agencies on Aging in lieu of the covered services from the state’s Medicaid HCBS waiver providers. Under the program, certain geographic areas of the state would be allowed to have their area agencies on aging to provide home modification and telehealth enhanced chronic care services to 1,000 eligible individuals. Eligible individuals for the program would come from the state’s Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) Program. The effort to find more cost efficient means to render services to this population is a result of increased utilization of HCBS services under Medicaid waivers in previous years. The measure now heads to the House Ways and Means Committee for consideration.
Kansas
Governor Kelly vetoes legislation banning gender affirming care for minors. Governor Laura Kelly (D) vetoed SB 63 this past week, which sought to ban gender affirming care for transgender minors. The measure aimed to prohibit medical interventions, inclusive of surgeries and hormone treatment for individuals under the age of 18. It notably would have also restricted state employees from promoting social transitioning for transgender youth. In the veto message, the Governor criticized the effort for interfering in medical decisions that should be made by parents and their children. Despite the veto, this was a core priority of Republicans in the Legislature this year and their supermajorities in both chambers are expected to attempt to override the measure. If that were to happen, it is likely the measure would face legal challenge to its constitutionality given a decision in a 2017 state supreme court case involving the right to abortion care. If the override is successful and the legal challenge unsuccessful, Kansas would join at least 26 other states that have enacted similar restrictions.
Louisiana
Department of Health will no longer promote mass vaccination efforts. Following release of a public message on February 13 iterating that vaccine mandates arising out of the COVID-19 Public Health Emergency were a mistake, the Department of Health has confirmed that they will no longer be promoting mass vaccination efforts. In the message from Dr. Ralph Abraham and Dr. Wyche Coleman, Louisiana’s Surgeon General and Deputy Surgeon General respectively, they note that the Department is shifting to a framework of personal responsibility and decision-making for healthcare matters. It’s expected that this will likely result in lost state funding for such purposes for local health departments across the state and in working with non-profit clinics and other healthcare providers.
Maine
Legislature fails to advance Medicaid supplemental budget. The Legislature failed to clear an emergency budget this last week that the Governor had pushed for to close a $118 million gap in Medicaid funding. Despite some Republicans supporting the measure in Committee the previous week, Republicans shifted and said they could no longer support the proposed supplemental for myriad reasons. Notably, they want larger reform to the state’s Medicaid program, such as the inclusion of work requirements. Legislative procedure requires a two-thirds majority vote of approval in Maine to pass a supplemental budget which necessitates Republican votes. Previously, the Governor’s administration had noted that failure to pass a supplemental budget would result in reduced Medicaid reimbursement to providers beginning as early as this Spring. It’s expected that another vote will be held on February 25.
Montana
Personhood bill advances through committee. Rep. Lee Deming (R-Laurel) is sponsoring HB 316, which would essentially nullify Constitutional Initiative 128 passed last year by voters. Passed along party lines out of the House Judiciary Committee recently, the measure would put a constitutional amendment before voters asking if they support a personhood amendment which would grant rights to an embryo upon conception. During the committee hearing, proponents acknowledged that it would create a de facto prohibition on the use of in vitro fertilization in the state. The measure would need to receive two-thirds votes in favor on both the House and Senate floors before advancing to the ballot in 2026. Given that Montana voted by an eight percent margin to enshrine a right to abortion services in their constitution in 2024, proponents may face a challenging path forward should the bill get through the Legislature. It now heads to the full Montana House floor for consideration.
House and Senate take action on Medicaid expansion bills. This past week, the Montana Senate and House took votes to sustain the Medicaid expansion program in the state. The full Senate voted against SB 62 on second reading by a margin of 30-20. The measure would have implemented a phase out of Medicaid expansion by prohibiting any new enrollments to the program and allow existing enrollees to remain on the program until they were no longer eligible. The measure had previously passed out of committee on a 6-5 margin but is not expected to receive further consideration on the floor. Out of the House, lawmakers passed HB 245 by a 63-37 margin and it removes the sunset date on the Medicaid expansion program and largely keeps the program in-tact as it currently operates in the status quo. That measure now heads to the Senate for consideration.
New Mexico
Behavioral health reform package passes Senate. The Senate passed a trio of bills this past week that would seek to reform behavioral health care resource delivery and investment in the state. As previously summarized in last week’s Weekly StateVitals Update, SBs 1, 2, and 3 found widespread bipartisan support in the Senate. The measures in brief summary would:
SB 1: Establishes a new Behavioral Health Trust Fund with an appropriation of $1 billion and a separate Behavioral Health Program Fund in the State Treasury.
SB 2: Appropriates $140 million to 13 state agencies for grants and assistance for housing service providers and other social service entities that may render treatment or services for behavioral health patients.
SB 3: Establishes behavioral health regions and authorizes the development of new standards for behavioral health services that are tailored to the region in which they’re being provided.
The measures will now head to the House for consideration.
North Carolina
Senate passes measure locking number of health coverage mandates. On Wednesday of last week, the Senate voted to pass SB 24 and send it to the House for consideration. The measure prohibits the General Assembly from adding any new mandated covered benefits unless they remove one currently from the list and in existing law. Under current law, North Carolina mandates coverage for 58 types of services or treatments that are applicable to non-ERISA plans subject to state oversight. Proponents of the measure contend that continuously adding new mandated benefits increases premiums for consumers and raises the cost of healthcare. Alternatively, Democrats in opposition to the measure contend that there are certain services not being covered that this measure would make challenging to do so, such as coverage for certain cancer screenings. This move to reign in healthcare costs comes as the State Health Plan in North Carolina has already provided notice this year that it plans to increase premiums in the near future.
North Dakota
Prior authorization reform bill passes through Senate committee. Last week, the Senate Industry and Business Committee unanimously adopted SB 2280. The measure establishes transparency requirements that insurers and prior authorization review organizations must comply with, including posting a list of all prior authorization requirements and restrictions on its website and providing providers with a 60-day notice before implementation of a new prior authorization requirement. The bill also requires all adverse determinations to be made by a physician, dentist or pharmacist. It also establishes a seven calendar day timeline for adverse determinations to be rendered for a requested prior authorization for non-urgent services and 72-hours for urgent services. The measure provides for a litany of other reforms, inclusive of a full prohibition of prior authorization for certain services, establishing an appeals process, and ensuring continuity of care for enrollees. The Senate committee hearing saw robust discussion on the issue but ultimately sent it to the full Senate where it’s waiting consideration on the floor.
Pennsylvania
House Health Committee passes bill to build rural healthcare workforce. Rep. Kathy Rapp (R-Warren), Chair of the House Health Committee, was successful in getting HB 157 passed out of her committee. The measure would establish the Rural Health Care Grant Program, with the intent to allow rural health facilities to help eligible providers under their employment in paying off any owed student loans. Eligible facilities would include FQHCs, rural health clinics, rural birth center or a rural hospital and eligible practitioners would include nurses, physicians, midwives, dentists and dental hygienists. The bill would cap the amount that any individual facility would have for disbursement at $250,000 annually and eligible practitioners are capped at receiving only the total amount that they owe in student loan debt. Additionally, eligible practitioners would be required to work for the facility that pays for their student loans for at least three years. The bill is now headed to the House floor.
Tennessee
Governor Lee addresses healthcare investments in State of the State. Governor Bill Lee (R) provided his seventh State of the State address this past week. In his address, he touted the innovation that the General Assembly was willing to take four years ago to help drive an effort to pursue block grant funding for Medicaid. The Governor credited savings of $1 billion in Medicaid costs since implementation to that effort. As part of his released budget with his state of the state, the Governor is focused on investing in other areas of healthcare for the new fiscal year. Notably, a $95.5 million investment via a shared savings program to enhance long-term care services and supports for older adults and individuals with disabilities. His budget also calls for $24 million to sustain a pilot program addressing unmet dental needs and investing in the dental workforce in the state. Over the coming weeks, lawmakers will react to the Governor’s proposed budget but it’s likely both of these efforts will move forward this session.
Wisconsin
State Senate committee hears bill on extending postpartum coverage. Despite previously publicized opposition from the House Speaker Robyn Vos (R-Racine County), the Senate Committee on Health held a hearing on SB 23 this past week. The measure would extend postpartum coverage to a full 12 months, just as 48 other states have previously done. During the hearing, all those testifying provided testimony in support of the measure and members of the committee expressed their support for the measure. However, the committee did not take a vote on the matter following the hearing. The measure in the Senate has 23 cosponsors and the companion bill in the House has 67 cosponsors. Despite this support, a similar measure passed the Senate last year and was then stalled in the House which is largely presumed to be a result of the House Speaker’s opposition to the policy proposal. It’s unknown whether this renewed support will convince the House Speaker to allow a vote on the measure in the House.
