Weekly StateVitals Update: Volume 85
National
CMS Clarifies Medicaid Medical Frailty Exclusion. Last Tuesday, the Centers for Medicare & Medicaid Services (CMS) released a slide deck with additional details on how states may implement medical frailty exclusions for Medicaid community engagement requirements. The slides expand on the recent Interim Final Rule, which allows exclusion from community engagement requirements if an individual’s condition significantly impairs their ability to comply. The slides also confirm that states must develop a list of conditions for medically frail individuals and include a three-tiered framework for identifying conditions that could qualify people as medically frail. The framework is as follows:
Tier 1 includes conditions the state can confirm significantly impair an individual's ability to comply with requirements based on readily available ICD-10 code data. CMS includes several example ICD-10 codes for states to consider in Tier 1, including codes related to pancreatic cancer, ALS, ESRD, and HIV resulting in encephalopathy.
Tier 2 includes individuals with a condition on the state’s exemption list that significantly impairs their ability to comply with community engagement requirements that cannot be determined with the ICD-10 code or other available coding. CMS suggests this tier could include individuals with multiple serious chronic conditions with high service utilization or repeated inpatient admissions for serious or complex conditions.
Tier 3 includes individuals with insufficient or no data and thus requires states to complete a manual individualized review for qualifying documentation.
States are not required to use CMS’ suggested tiered frameworks. While 25 states and DC filed a lawsuit to block implementation of community engagement requirements, a federal judge denied their request for a preliminary injunction. Oral arguments for the case are scheduled for October 20, 2026; however, states are still preparing for the requirements to become effective January 1, 2027.
Idaho
Supreme Court Approves Redrafted Abortion Ballot Initiative Language. Last Sunday, the Idaho Supreme Court approved redrafted ballot language for Proposition 1, which seeks to establish reproductive and privacy rights and overturn the state’s near-total abortion ban. In a 4-1 opinion, the court found that Attorney General Raúl Labrador (R) and Secretary of State Phil McCrane (R) did not comply with statutory requirements for a clear and concise statement on the effects of “yes” and “no” votes. In addition to Idaho, voters in Virginia and Nevada will consider similar measures on November 3, while Missouri voters will decide whether to reinstate a previously overturned ban on abortions. In Missouri, the same ballot initiative also seeks to prohibit gender affirming care medical procedures for minors.
Louisiana
Fifth Circuit Panel Hears Oral Arguments on Reinstating In-Person Mifepristone Dispensing. Last Wednesday, a Fifth Circuit panel heard oral arguments regarding Louisiana’s request to stay the Food and Drug Administration’s (FDA) decision to remove in-person dispensing requirements for Mifepristone. This hearing follows a Fifth Circuit panel’s decision to stay the 2023 FDA rule back in May, which would have paused mail-order availability for the medication nationwide. The U.S. Supreme Court quickly weighed in, blocking the Fifth Circuit order as litigation continues and leaving mifepristone accessible via telemedicine and the mail for the time being. Given this precedent, the panel questioned its authority to block the FDA decision. Additionally, the panel discussed whether Louisiana has standing to challenge the decision and if the decision even approves of mailing mifepristone into states with abortion bans. The panel has yet to issue a ruling, though a decision is expected by the end of 2026.
Michigan
CMS Announces $25 Million for Health Technology, Telehealth, and Remote Patient Monitoring. Recently, the Centers for Medicare & Medicaid Services (CMS) announced that Michigan has awarded $25 million in Rural Health Transformation Program funding to improve health technology and health system connectivity. The funding is intended to modernize technology, upgrade digital systems, improve health data exchange and connectivity, and expand telehealth, remote patient monitoring, and care coordination. This funding comes in addition to $70 million of previous RHTP awards to strengthen health data interoperability, rural health partnerships, and the rural healthcare workforce in Michigan. These awards represent part of the state’s $173 million in first-year RHTP funding.
Texas
Health and Human Services Commission Requests $6 Billion for Medicaid and Health Services. Recently, the Texas Health and Human Services Commission (HHSC) released its Legislative Appropriations Request for fiscal years 2028 and 2029. The request includes $105.8 billion in base funding and $6.2 billion in additional requests. Outside base funding, the largest requests include $4.6 billion for Medicaid entitlement cost growth, $515.3 million to operationalize inpatient capacity, $212.4 million for eligibility operations, and $206.2 million for Medicaid waiver cost growth. These requests align with a 3% reduction in the state’s base budget, exempting Medicaid and the Children’s Health Insurance Program due to administrative savings, program reductions or eliminations, and regulatory fee revenue. Through December, the Legislative Budget Board and Governor Greg Abbott’s (R) Office of Budget, Planning, and Policy will hold hearings on the request and prepare separate recommendations to present to the legislature. Texas’ legislature is scheduled to reconvene on January 12, 2027.
Surrogate Requests Supreme Court Appeal in Ongoing Abortion and Medical Rights Case. This past Wednesday, a California couple’s surrogate from Alaska, who gave birth in Texas and refused the couple’s alleged wishes to have an abortion after learning of the baby’s serious heart defect during pregnancy, filed an emergency appeal to the U.S. Supreme Court to intervene in the ongoing custody battle. Texas Attorney General and U.S. Senate candidate Ken Paxton (R) previously intervened in the case, securing an order for a Dallas County hospital to provide life-saving care for the heart condition once the baby was born on August 12. On August 25, a Dallas County District Judge heard arguments and testimony from the intended parents and surrogate and extended a temporary restraining order barring the surrogate from seeing or making medical decisions for the baby. The surrogate’s appeal asks the Supreme Court to halt a California court order recognizing the couple, and not the surrogate, as the parents of the child. Critically, this litigation raises debate regarding state laws on parentage and custody that could arise in multi-state surrogacy agreements and could lead to hospitals and providers being pulled into custody and consent disputes.
Vermont
State Agencies Award $ 11.7 Million for the Rural Healthcare Workforce and Long-Term Care. Last Thursday, the Vermont Department of Health (VDH) and the Department of Disabilities, Aging, and Independent Living (DAIL) announced they had distributed a combined $11.7 million in Rural Health Transformation Program (RHTP) funds. VDH awarded $9 million to provide tuition benefits for people pursuing education in health-related fields who commit to serve rural communities for at least five years after graduating. Eligible fields include, but are not limited to, nursing, dentistry, mental health, and emergency medical services. Additionally, DAIL awarded $2.7 million to support rural nursing homes’ capacity to serve residents with complex medical issues and to expand Licensed Nursing Assistants training so they can serve in rural healthcare and long-term care settings. These announcements represent the first two funding awards of the state’s $195 million in first-year RHTP funding; additional announcements are expected in the coming months.
Washington
Governor Ferguson Issues Executive Order to Respond to H.R. 1 Medicaid Changes. Recently, Governor Bob Ferguson (D) signed Executive Order 26-03, outlining the state’s response to federal Medicaid changes under H.R. 1. The executive order establishes a one-year Continuous Medicaid Response Committee to monitor federal health coverage changes and issue recommendations to Governor Ferguson. Additionally, the order directs state health agencies, including the Health Care Authority (HCA) and the Department of Social and Health Services (DSHS), to take several actions to help retain residents’ Apple Health coverage, including:
Requires HCA and DSHS to use the shortest permissible look-back periods, allow for self-attestation, use post-eligibility verification when permissible, leverage existing exemption qualifying data, and reduce the need for duplicative eligibility document submissions.
Directs HCA and DSHS to identify alternate coverage options for enrollees who lose Apple Health coverage, connect residents to work and training opportunities, and issue information for individuals whose coverage is impacted by immigration-related eligibility requirements.
Directs the Department of Health to establish a data-tracking framework within 90 days to measure and report on the short- and long-term impacts of federal policy changes on state health outcomes and coverage.
Looking ahead, the Continuous Medicaid Response Committee is expected to submit a proposal on creating a Healthcare Access and Affordability Council in early October. The council will be tasked with developing short-term and long-term strategies to retain healthcare coverage and control costs.
West Virginia
Governor Morrisey Announces $4.8 Million for the Rural Healthcare Workforce and Preventative Care. Last Wednesday, Governor Patrick Morrisey (R) announced West Virginia was investing $2.4 million through the Rural Health Transformation Program (RHTP) for the rural healthcare workforce. The investment supports a statewide recruitment and relocation program for the rural healthcare workforce, aiming to recruit 125 licensed professionals in the first year. Morrisey’s announcement came shortly after the state issued its first RHTP award of $2.4 million to expand worksite clinics and employer-based healthcare services to improve access to preventive care, health screenings, chronic disease management, and other services. The state is expected to release additional RHTP funding announcements in the coming months, detailing investments for the remainder of its $199.5 million in first-year funding.