Weekly StateVitals Update: Volume 88 (October 5, 2026)
National
Attorneys General Sue States with Abortion Shield Laws. Last Wednesday, Attorneys General Liz Murrill (R-LA), Steve Marshall (R-AL), and Tim Griffin (R-AR) sued California, Massachusetts, and New York over their shield laws that protect abortion providers and patients from out-of-state actions. Attorney General Murrill filed complaints at both the federal district level and with the U.S. Supreme Court. The lawsuit filed with the Supreme Court alleges that the blue states’ shield laws violate the U.S. Constitution’s Full Faith and Credit Clause, which requires states to respect the laws and proceedings of other states, along with the equal-sovereignty doctrine, the federal common law of public nuisance, and the Dormant Commerce Clause. The complaint filed in Louisiana’s Western U.S. District Court instead lists 30 medical providers and organizations as defendants, alleging they provide abortion medication without a medical consultation to Louisiana patients and misrepresent the risks of the drugs such as mifepristone. Notably, attorneys general from abortion-restricting states have challenged shield laws before, including those in California, Delaware, and New York. These challenges, along with the recent filings, are expected to take years to resolve and may ultimately be decided by higher courts. In the meantime, more lawsuits are likely to follow.
CMS approves Medicaid Section 1115 Reentry Waivers for Three States and DC. Recently, the Centers for Medicare & Medicaid Services (CMS) approved new Section 1115 demonstration waivers for Louisiana, Minnesota, and Nevada to provide reentry services under their Medicaid programs. In particular, states may now provide pre-release Medicaid services to eligible incarcerated individuals within 60 days prior to their release. Additionally, CMS approved the District of Columbia’s renewal request for its Whole-Person Care Transformation Section 1115 waiver. With the approval, DC may continue to provide beneficiaries staying in an institution for mental diseases with Medicaid coverage for substance use disorder or serious mental illness. DC’s renewal also authorizes the state to add reentry services for eligible incarcerated individuals before their release. All four demonstrations are effective from October 1, 2026 through September 30, 2031.
Alabama
Governor Ivey Releases $55 Million for Rural Digital Health, EMS, and More. Last Thursday, Governor Kay Ivey (R) announced the second round of Rural Health Transformation Program (RHTP) funding had been released, amounting to nearly $55 million across 34 grants. The funding was awarded across five initiatives: Cancer Digital Regionalization, Statewide EMS Trauma and Stroke, EMS Treat in Place, Maternal and Fetal Health, and Simulation Training. To round out its first year funding awards, Alabama awarded an additional $29 million for rural health workforce training as well as equipment, patient intake, and coordinated care support.
Arizona
Attorney General Mayes Alleges PBMs Contributed to Opioid Epidemic. Last Thursday, Attorney General Kris Mayes (D) filed a lawsuit against two pharmacy benefit managers (PBMs), alleging they engaged in deceptive practices that contributed to the opioid epidemic and violated the state’s Consumer Fraud Act. AG Mayes’ complaint alleges the PBMs prioritized rebate revenues from drug manufacturers over patient safety. In particular, the lawsuit points to the PBMs securing preferred formulary status for opioids and bypassing prior authorizations or step therapy. Additionally, AG Mayes accused the PBMs of distributing misleading educational materials downplaying addiction risks, selling prescriber data to manufacturers for targeted marketing, and failing to prevent drug diversion in mail-order pharmacies. The suit was filed in an Arizona Superior Court in Maricopa County and seeks restitution, civil penalties, profit disgorgement, corrective programs, and a court order to stop the challenged practices.
California
Governor Newsom Enacts Law to Increase GLP-1 Access. Last Monday, Governor Gavin Newsom (D) signed SB 1089 into law, paving the way for expanded access to glucagon-like peptide-1 (GLP-1) medications under CALRx, the state’s drug purchasing program. SB 1089 authorizes the California Health and Human Services Agency (CHHSA) to partner with drug manufacturers to increase competition, lower prices, and address supply shortages for at least one FDA-approved anti-obesity GLP-1 medication. Additionally, the law directs CHHSA to partner with distribution partners as needed and to negotiate GLP-1 pricing to at or below the cost to Medi-Cal beneficiaries in 2025. While CALRx also distributes insulin, albuterol inhalers, and naloxone, implementation timelines have varied. CHHSA took three years to provide discounted insulin coverage, and efforts to include GLP-1s are expected to be a multi-year endeavor as well.
Governor Newsom Enacts Prior Authorization and Provider Network Laws. Recently, Governor Gavin Newsom (D) enacted two bills imposing new requirements for provider directories and rare disease drug prior authorizations. AB 280 directs the Department of Managed Health Care to select a central utility and develop uniform provider directory standards. Once selected, health service plans and health insurers must submit their provider directories to the central utility and use it to manage their directories and verify their completeness. Additionally, insurers will be required to cover all benefits provided to enrollees who relied on information in the directory. The law becomes effective July 1, 2027.
Starting January 1, AB 1887 requires all healthcare service plans and health insurers to complete prior authorizations for FDA-approved rare disease drugs within 30 days and prohibits step therapy requirements. To be eligible for the expedited prior authorization timelines, the drug must be prescribed by a specialist experienced in treating the disease who determines the drug is medically necessary and the only available FDA-approved treatment. Previous versions of the law were less stringent, exempting drugs with available biosimilars and generics from the 30-day timeline; however, the Senate amended the exemption out.
Colorado
Governor Polis Awards $169.6 Million in RHTP Grants. This past Monday, Governor Jared Polis (D) and the Colorado Department of Health Care Policy and Financing (HCPF) announced the state was awarding $169.6 million in Rural Health Transformation Program (RHTP) grants. The funding will support approximately 250 projects across 91 providers, covering a wide range of initiatives. Notable investments include funding for behavioral health, care coordination, telehealth, rural health workforce training and recruitment, EMS, mobile and community-based health services, maternal health, pediatric care, a whole blood supply, electronic health record modernization, and regional partnerships. Colorado still has $30.5 million remaining in first-year RHTP funding, which the state is expected to award by the end of the month.
Idaho
Department of Health and Welfare Plans to Implement MCO Late Payment Penalties. Recently, the Idaho Department of Health and Welfare (DHW) presented to the legislature’s Medicaid Review Panel on planned provider protections as the agency continues its work to transition to a fully capitated Medicaid managed care model. During the meeting, DHW noted it intends to impose late payment penalties on Medicaid managed care organizations (MCOs), distributing the funds to the requesting provider. In addition to prompt payment requirements, Senator Kevin Cook (R) asked DHW about consistency in MCO contracts for prior authorizations. DHW noted it is developing standard prior authorization policies for key services and that utilization management standards will not be more restrictive than Idaho’s fee-for-service policies. In response to Senator Melissa Wintrow (D), DHW also noted it plans to make payment metric data and prior authorization approval and denial rates and denial reasons publicly available. Looking ahead, Medicaid Director Sasha O’Connell stated DHW may have to further delay implementation of managed care past 2030 due to ongoing litigation over a contract award for Idaho’s Medicaid claims processing system. The review panel is expected to meet again in November to decide on the implementation timeline. DHW also announced that a blackout period for the comprehensive Medicaid managed care request for proposals will begin on December 1, 2026.
Maine
CMS Approves Maine Section 1115 Waiver Renewal with Reentry Expansion. Recently, the Centers for Medicare & Medicaid Services (CMS) approved Maine’s request to renew its Medicaid section 1115(a) waiver, the Maine Whole Person Care Waiver, from October 1, 2026 to September 30, 2031. Through the approval, MaineCare will continue to provide substance use disorder services and offer additional coverage for parents, home-based skill development, and parenting supports. Additionally, MaineCare will now include coverage for traditional health care practices, serious mental illness services in institutions for mental diseases, and pre-release services for up to 60 days before an eligible individual is released from jail or prison and 90 days before release from youth correctional facilities. The pre-release services will authorize access to case management, prescription medication, medication-assisted treatment, and physical and behavioral health services. Pre-release services continue to grow as a Medicaid support area, with Louisiana, Minnesota, and Nevada recently receiving CMS approval to include them under their programs.
Montana
Governor Gianforte Announces $8.7 Million in RHTP Funds for Rural EMS. Last Tuesday, Governor Greg Gianforte (R) and the Department of Public Health and Human Services announced that the state had awarded $8.7 million in Rural Health Transformation Program (RHTP) funds for EMS. In particular, the funding will support 78 EMS agencies in purchasing equipment and ambulances so they can serve rural and frontier communities. Governor Gianforte’s announcement highlighted that the highest requested items in grant applications consisted of specialized equipment, including IV pump systems and ventilators. Montana received a first-year award of $233.5 million and is expected to release additional rounds of funding for EMS modernization through 2030.
Tennessee
Sixth Circuit Upholds Block on Law Restricting Provision of Abortion Information to Minors. Recently, the U.S. Sixth Circuit Court panel upheld a U.S. District judge’s permanent block on a portion of Tennessee’s 2024 law (SB 1971) restricting adults' ability to give out information about legal out-of-state abortions to minors. The law would have made it a felony to intentionally recruit, harbor, or transport a pregnant minor for an abortion without parental consent. However, the district judge found the law vague and in violation of the First Amendment for not defining “recruit.” In the panel, Senior Judge Jane Stranch ruled that Tennessee had no compelling interest in shielding its citizens from information about activities outside its borders and that while the state criminalizes speech that encourages minors to get an abortion, it is silent on speech encouraging minors to carry a pregnancy to term with or without parental involvement.
Texas
Governor Abbott Announces $51 Million for Prevention, Wellness, and Nutrition Programs. This past Monday, Governor Greg Abbott (R) announced Texas’ first round of Rural Health Transformation Program (RHTP) funding awards, which provide $51 million for community-based prevention, wellness, and nutrition programs. The funding comes through the state’s Make Rural Texas Healthy Again initiative, which aims to help rural hospitals reduce the burden of chronic diseases such as diabetes, cardiovascular disease, chronic respiratory disease, and obesity and improve health outcomes. Notably, Texas received the highest first-year funding amount of any state at $281.3 million and is expected to make significant funding awards toward consumer-facing health information portals, artificial intelligence and telehealth, rural healthcare workforce training, cybersecurity, and equipment investments for various rural health providers.