Weekly StateVitals Update: Volume 89 (October 13, 2026)
National
CMS Releases Final Rule on Healthcare Price Transparency. Recently, the Centers for Medicare & Medicaid Services (CMS) announced final updates to the Transparency in Coverage (TiC) rules, which aim to improve the price transparency files available to payers and providers. The updates will reduce duplicative information, contextualize in-network prices, increase out-of-network pricing information, strengthen accountability for submitting accurate and complete data, and decrease reporting frequency from monthly to quarterly. The rules will also require health insurers to provide enrollees with personalized cost-sharing information by phone, in addition to existing online requirements. Looking ahead, the Departments of Labor and the Treasury will develop the initial schema for the Prescription Drug File in November 2026 and finalize it by May 2027. Plans and issuers will be expected to publish their Prescription Drug Files using the schema every month beginning in December 2027. The updated regulations are effective December 7, 2026.
Five Governors ask HHS to Delay Medicaid Work Requirement Implementation. Recently, Democratic governors Tina Kotek (OR), Gavin Newsom (CA), Janet Mills (ME), Michelle Lujan Grisham (NM), and Abigail Spanberger (VA) asked U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. to delay the January 1, 2027 compliance date for Medicaid work requirements. The governors said they cannot responsibly implement the rules before the deadline and asked HHS to tie the compliance date to demonstrated state readiness rather than a calendar date. The governors noted that the June 1 interim final rule reversed federal guidance previously given to states on medical frailty, compliance activities, and work status verification, and that rushed implementation would cause eligible beneficiaries to lose coverage. Critically, the governors did not ask to outright block the work requirements, meaning the request does not affect the pending state legal challenges to the interim final rule.
California
Doctors and Insurers Sue Newsom Administration over Premium Increases. Recently, the California Medical Association and the California Association of Health Plans sued state officials over SB 125, which would implement a managed care organization (MCO) tax that would lower taxes on Medi-Cal plans and raise taxes on private health plans to the same level. The lawsuit alleges that the bill violates an approved 2024 ballot measure that permanently authorized a tax on MCOs, dedicated MCO tax revenues to specified purposes, and established a limit on the tax imposed on commercial enrollment. Legislators introduced the change in response to new federal rules that require states to restructure their MCO taxes. California’s new tax plan would require federal approval before going into effect. In response to the tax increase, private health insurers indicated they will raise premiums by about $100, shifting the cost burden onto enrollees.
Florida
Department of Health Holds Public Hearing on Repealing School Vaccine Requirements. Last Thursday, the Department of Health held a pubic hearing on proposed revisions to remove school immunization requirements for four vaccines. In particular, the revisions would remove the requirements for hepatitis B, varicella (chickenpox), Haemophilus influenzae type b (Hib), and pneumococcal conjugate to attend Florida schools. The Department’s proposed rule has come under criticism for the past year; healthcare professionals and parents of immunocompromised children warned against the negative health effects of repealing the vaccines. However, Surgeon General Dr. Joseph Ladapo argued the decision would improve parents’ rights and thus benefit the state's overall health. Governor Ron DeSantis (R) has previously tried to pass legislation (HB 917/SB 1756 from the regular session, and SB 6D from a special session) to end vaccine mandates, though his efforts remain unsuccessful.
Indiana
FSSA Estimates 58,000 Hoosiers Are Not in Compliance with Medicaid Work Requirements. Recently, the Indiana Family and Social Services Administration (FSSA) estimated that 58,000 enrollees were not in compliance with Medicaid work requirements and underscored the need for members to review their status to avoid losing coverage. HIP currently covers over 400,000 individuals, and at the current non-compliance rate, up to 12% of members could lose coverage once the agency begins enforcing Medicaid work requirements. Critically, Indiana has opted for a three-month look-back window, meaning individuals applying for or renewing HIP coverage in January should be in compliance with requirements this month.
Louisiana
FDA Expects to Complete Mifepristone Safety Review by March 2027. This past Tuesday, the U.S. Food and Drug Administration (FDA) stated it expects to complete its safety review of mifepristone by March 2027, extending past the previous review timeline of December 2026. The update came at the request of a federal judge in Louisiana. The agency confirmed it expects to receive the study results by December 2026 but will likely need more time to review them. Several cases challenging the FDA’s approval of mifepristone and its authorization of mail-order dispensing await the results of the safety review. The Fifth Circuit panel heard oral arguments in September on Louisiana’s request to block the FDA’s decision, but it has not yet issued a ruling. Notably, a federal judge in Texas granted the FDA’s request to stay a lawsuit seeking to revoke FDA approval of mifepristone altogether, but set a deadline of December 1, 2026, or until the safety review is completed. Due to the delay, the Texas proceedings could resume on December 1.
Nebraska
Governor Pillen Receives Praise from CMS Administrator Oz on Rural Health and Medicaid Community Engagement Requirements. Last Saturday, Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz (R) congratulated Governor Jim Pillen (R) on distributing Rural Health Transformation Program (RHTP) funds and implementing Medicaid community engagement requirements. Nebraska was the first state to implement the requirements, choosing to do so on May 1, 2026. Accordingly, Nebraska was the first state to disenroll Medicaid recipients in July; Nebraska’s Department of Health and Human Services (DHHS) expected the first round to remove about 200 people. Later analysis from KFF found that about 1,100 Nebraskans lost Medicaid coverage, with DHHS denying coverage to 14% of new applicants and 7% of renewing applicants. Additionally, DHHS CEO Steve Corsi said the program removed 600 to 900 people and was working exactly as designed.
Texas
Attorney General Paxton Investigates Health Insurer Over Coverage Denials. Recently, Attorney General Ken Paxton (R) announced an investigation into a health insurer over alleged unlawful utilization management and coverage-denial practices. AG Paxton noted allegations that the insurer bribed nursing homes to delay patient hospitalizations and highlighted a case where the insurer withdrew approval of a completed procedure after previously approving a prior authorization request. AG Paxton also said the insurer’s “coverage determinations may amount to the corporate practice of medicine overriding physicians' judgment and directing medical care.” Addressing coverage denial rates, patient access to care, and rising premiums remain priorities across states, including recent developments in California and Idaho.
Utah
Office of AI Policy Expands Healthcare AI Sandbox and Oversight. Recently, the Utah Office of Artificial Intelligence Policy announced that they were expanding the state’s AI regulatory sandbox program with new healthcare pilots. The authorized pilots include public and private entities and will test AI implementation for prescription renewals, dermatology, and physical therapy. Simultaneously, state officials noted they are increasing physician oversight, creating a new clinical AI advisory group and a network of independent third-party evaluators to audit the pilots. Nationwide, states have continued to regulate AI use in healthcare over the past year, requiring licensed professional review of AI-supported decisions. Utah’s AI regulatory sandbox stands out as the first of its kind, initially gaining the spotlight after it began a partnership last January to test automatic AI prescription renewals.
Vermont
Federal Judge Denies Preliminary Injunction Against 340B Contract Pharmacy Law. Last Tuesday, a Vermont federal district court denied a request for a preliminary injunction against the state’s 340B contract pharmacy law, H. 266 (2025). The law prohibits drug manufacturers from interfering with the acquisition or delivery of 340B drugs to contract pharmacies or with the pharmacies’ dispensing of 340B drugs to eligible patients. In denying the plaintiff’s motion to block the law, Judge Mary Lanthier found that the Constitution’s Supremacy Clause did not preempt H. 266 as field or conflict preemption. Additionally, Judge Lanthier granted Vermont’s partial motion to dismiss the complaint that H. 266 was vague for not defining “interfere” and thus void under the Due Process Clause. Lanthier reasoned that H. 266 still provided sufficient notice of prohibited conduct and therefore was not impermissibly vague. This ruling follows a recent district court decision denying a preliminary injunction against New Mexico’s 340B law, HB 78 (2025), which found it was neither conflict-preempted nor field-preempted because the 340B statute is silent on drug delivery.