Weekly StateVitals Update: Volume 81 (August 17, 2026)

National

• President Trump Issues Executive Order on Childhood Vaccine Recommendations. Last Monday, President Donald Trump signed the expansive Executive Order 14420 on childhood vaccine guidance, calling for the MMR vaccine to be split into single-disease shots and issuing “Gold Standard Childhood Vaccine Recommendations.” The recommendations reduce routine childhood vaccine recommendations from 17 to 11 diseases and downgrade several others to “Shared Clinical Decision Making” status. Notably, these recommendations align with the Department of Health and Human Services (HHS) and  Centers for Disease Control and Prevention (CDC) schedule released in a January 2026 memo following votes by the reconstituted Advisory Committee on Immunization Practices (ACIP) and later blocked by a federal court in March. As it stands, what the executive order can accomplish legally is unclear; states still have and continue to exercise authority in deciding which vaccine recommendations to follow. 

Delaware

• Legislators Voice Concern over Creation of New Surgeon General Position. Recently, Delaware’s legislative leadership expressed concern over Governor Matt Meyer (D) creating a state Surgeon General position via executive order (DE EO 26-24)  last month. Gov. Meyer selected the chair of the Health Care Commission, Dr. Neil Hockstein, to fill the role. According to State Senate President Pro Tem Dave Sokola (D) and House Speaker Melissa Minor Brown (D), Gov. Meyer did not discuss the decision with them, despite their responsibility to review and confirm new appointments. Sokola and Brown support the position, though they still plan to review and confirm the Surgeon General and several other Meyer appointees during an upcoming fall special session. During this time, Dr. Hockstein will testify before the General Assembly.

Florida

• Governor DeSantis Announces $188 Million in RHTP Awards. Last Tuesday, Governor Ron DeSantis (R) announced approximately $188 million in rural health transformation program (RHTP) funding awards. The awards went to hospitals, Federally Qualified Health Centers (FQHCs), rural health clinics, and other health care providers and community organizations across 31 rural counties. The investments support initiatives that strengthen healthcare quality, access, and personnel across rural communities, including expanded clinical training and rural rotations, start-up funding for rural and satellite clinics, mobile health units, remote patient monitoring, and advanced telehealth services. With these rewards, the state has allocated the entirety of its $209 million in first-year funding. 

Illinois

• Drug Manufacturers File Lawsuits Against New 340B Laws. Recently, two drug manufacturers filed lawsuits to block the enforcement of the recently passed 340B contract pharmacy and covered entity law, HB 2571. As enacted, the law prohibits drug manufacturers from interfering with covered entities’ or contract pharmacies’ acquisition of 340B drugs and mandates transparency requirements for covered entities. Specifically, the lawsuits argue that HB 2571’s contract pharmacy provisions violate the Supremacy, dormant Commerce, and Takings Clauses of the U.S. Constitution. Notably, shortly after the manufacturers sued, a federal judge in South Dakota dismissed three other lawsuits challenging the state’s similar law. With several legal battles in circuit courts across the country and a revised federal 340B rebate model, litigation over the 340B program is expected to continue into next year. 

• Governor Pritzker Enacts Private Equity Oversight and Drug Distribution Laws. Recently, Governor J.B. Pritzker signed 75 pieces of legislation into law, including two bills covering healthcare transactions and drug distribution. HB 5000 expands the scope of healthcare transactions that require prior 30-day notice to the Attorney General to include those involving parent or private equity companies that own or control Illinois health care facilities or an out-of-state entity generating over $10 million in revenue. It also removes the 2027 repeal date from the previous healthcare transaction law, making it a permanent feature of private equity oversight in healthcare in the state absent future amendments or repeal. Additionally, HB 4953 authorizes drug manufacturers and wholesale drug distributors to deliver prescription drugs to a licensee’s business address or an authorized entity, instead of only the premises listed on the license. However, it still requires that a manufacturer or wholesale distributor deliver controlled substances only to registered places of business or professional practice. Both laws go into effect on January 1, 2027.

Indiana

• FSSA Prepares HIP 3.0 Section 1115 Demonstration Application. Recently, the Indiana Family and Social Services Administration (FSSA)  announced it plans to submit a five-year Section 1115 demonstration waiver application for Healthy Indiana Plan (HIP) 3.0 to Centers for Medicare & Medicaid Services (CMS). HIP currently provides Medicaid coverage delivered through managed care organizations (MCOs) for adults ages 19 to 64. population. As proposed, the waiver would transition coverage for the expansion population to a standalone Section 1115 demonstration, reintroduce member cost-sharing, and establish incentives that reduce copayments for members who complete preventive care visits or other healthy activities. The demonstration would cap cost-sharing at 5% of a member’s quarterly income. The state is currently undergoing its own public comment period before it submits to CMS for consideration. Public comments may be submitted to FSSA through September 4th, and, if approved, the demonstration would take effect on October 1, 2027.

• Medicaid Fraud Control Unit Named Unit of the Year by HHS. Last Tuesday, Attorney General Todd Rikita (R) announced that the Department of Health and Human Services (HHS) named the state’s Medicaid Fraud Control Unit (MFCU) the U.S. MFCU of the Year. Since January 2021, the MFCU has recovered $109 million in Medicaid provider fraud; in the last 12 months, it secured 50 indictments or charges, 40 convictions, and referred 60 individuals for exclusion from Medicaid. HHS’ recognition of Indiana’s MFCU unit builds on the already prevalent federal support for the state’s program integrity initiatives. Recently, Indiana partnered with the Centers for Medicare & Medicaid Services and Oracle for an AI Medicaid fraud-detection pilot that notably evaluates the use of AI-generated investigative case packages to accelerate enforcement. As federal approval grows, it is increasingly likely that CMS will push Indiana’s pilot as a model for other state Medicaid programs to adopt.

Maryland

• Advocates Push State Candidates to Support Upcoming UPL Bill. This past Wednesday, the grassroots organization Maryland Health Care for All said it was sending letters to every Maryland General Assembly or gubernatorial candidate to commit to approving a bill in the upcoming 2027 legislative session. According to the organization, the bill would allow the state’s Prescription Drug Affordability Board (PDAB) to quickly set upper payment limits (UPLs) for drugs that match the negotiated Medicare maximum fair price (MFP). Delegate Jennifer White Holland (D), representing Baltimore County, is expected to sponsor the legislation. Notably, Maryland’s PDAB already set UPLs for Ozempic and Jardiance for state and county employees for January 2027 and will expand the UPLs to cover all residents beginning January 1, 2028. Additionally, the Centers for Medicare & Medicaid Services (CMS) has selected 40 drugs to have Medicare MFPs by 2028, and is expected to select an additional 20 for 2029 and every year thereafter. 

Massachusetts

• Governor Healey Enacts Statewide Licensing System for Home Care Agencies. Recently, Governor Maura Healey (D) signed H 5627 into law, creating a statewide licensing system and regulatory framework for home care agencies and implementing new worker protections. The act also includes language that:

  • Establishes requirements for background checks, training, and standards to address abusive treatment of workers and consumers.

  • Makes it unlawful for a consumer to discriminate against their personal care attendant. 

  • Directs the newly established Home Care Oversight Advisory Council to advise on the licensing system.

  • Creates a Home Care Worker and Abuse Stakeholder Advisory Committee to study safety issues affecting worker and consumer safety and recommend additional protections.

  • Establishes a special commission to study family caregiving policy, including the impacts of allowing spouses to serve as paid caregivers in the MassHealth program.

  • Creates a special commission to study the creation of a statewide long-term services and supports benefit program.

  The Executive Office of Health and Human Services (EOHHS) will have the authority to inspect and investigate agencies, enforce compliance, impose penalties, and deny, suspend, or revoke licenses. EOHHS is expected to work on all aspects of the law in the coming months.

• Governor Healey Signs Law Expanding Abortion Protections. Last Monday, Governor Maura Healey (D) signed H 5595 into law, which expands the authority for physicians’ professional judgment when it comes to providing abortions. As enacted, the law eliminates the list of specific conditions required to justify an abortion after 24 weeks, instead allowing an abortion to be performed based on a physician’s professional judgment. Additionally, the bill prohibits a medical review process from overriding the professional judgment of a physician and the patient or their health care proxy and repeals a legal provision requiring informed consent for such abortions. With the new law, Massachusetts became the 10th state not to have gestational limits for abortion, joining Alaska, Colorado, Maryland, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Vermont, and the District of Columbia. 

South Dakota

• Federal Judge Dismisses Trio of Lawsuits Challenging 340B Law. Recently, U.S. District Court Judge Roberto Lange dismissed three lawsuits from drug manufacturers and a trade group challenging the state’s 340B law (SB 154). The 2025 law prohibits drug manufacturers and wholesale drug distributors from interfering in contracts between 340B entities and pharmacies. In his dismissal, Judge Lange reasoned that participation in 340B is optional, and thus cannot amount to an alleged illegal taking of the manufacturers' products and forced discounted sale. He also ruled that SD 154 does not unfairly burden interstate commerce because the state has a legitimate interest in regulating 340B drugs dispensed to residents. Moreover, because the law addresses drug delivery rather than pricing, he stated it does not alter how the 340B statute is structured. The decision follows recent lawsuits against Illinois’ 340B law and another dismissal of challenges against Maine’s 340B law. The Eighth Circuit Court is expected to review any notices of appeal in the coming month. 

Wyoming

• Rural Health Panel Approves $205 Million in RHTP Awards. Last Tuesday, the Wyoming Rural Health Transformation Advisory Committee met to divvy up $205 million in funding awards through the state’s Rural Health Transformation Program (RHTP). To make the awards, the committee used application scores from health department staff and issued conditional funding approvals to some applicants, provided they met specific funding criteria. Critical access hospitals received the bulk of the approved awards ($48.2 million). In comparison, awards for workforce education and individual support ($35.4 million), integrated primary care ($30.5 million), EMS regionalization ($23.3 million), and physician graduate medical education ($17.7 million) were the next-largest categories. Notably, Wyoming received the second-highest funding per capita, after Alaska, signaling federal approval of the state’s RHTP application. The state now has until the end of October to finalize funding awards.