Weekly StateVitals Update: Volume 90 (October 19, 2026)

Georgia

• Department of Community Health Requests to Increase FMAP for Medicaid Expansion Program. Recently, the Centers for Medicare & Medicaid Services (CMS) announced that the Georgia Department of Community Health (DCH) requested an amendment to its 1115 Demonstration extension to increase the federal medical assistance percentage (FMAP) for its Pathways to Coverage Section 1115 Demonstration population to 90%. The waiver consists of a partial Medicaid expansion program, providing coverage to low-income adults with incomes up to 100% of the federal poverty level. In explaining its request, DCH noted the changes H.R. 1 brought to the Medicaid landscape and the additional populations the program covers. DCH submitted a five-year extension request for the program back in 2025, though CMS approved an alternative extension through December 31, 2026. The public comment period for the request will be open through November 8, 2026.

Idaho

• Health Insurers Working Group Votes on Draft Legislation. Last Wednesday, the Idaho Health Insurers Working Group voted on subject areas to draft legislation related to healthcare access. Notably, the group voted to draft prior authorization reform legislation, though previous attempts have not gained traction in the legislature. During this past session, legislators introduced HB 611, which would have established timelines for prior authorization approval and validity; however, it never received a hearing. In addition to prior authorization, draft legislation from the working group may cover the following subjects:

  • Setting payment standards for providers and insurers to reduce delayed reimbursements

  • Establishing uniform credentialing standards for providers through insurers

  • Requiring the Department of Insurance to report to the Legislature on payment timeliness and healthcare denial rates. This may also include information on the Independent Dispute Resolution (IDR) process, created by the No Surprises Act (2020).

  As of today, the working group has not yet scheduled any subsequent meetings.

Maine

• Hospital Associations and Hospitals Sue HRSA over Revised 340B Rebate Pilot. Recently, the American Hospital Association (AHA), the Maine Hospital Association, and several Maine hospitals sued the Health Resources & Services Administration (HRSA) over the revised 340B Rebate Model program. Filing the case in the Maine U.S. District Court, the plaintiffs seek a preliminary injunction against the revised pilot, alleging that allowing drug manufacturers to provide 340B pricing through rebates instead of up-front discounts threatens the financial viability of covered entities. In particular, the hospitals argue they operate with limited cash on hand, making it difficult to pay the market prices upfront and implement necessary administrative changes while waiting for rebates. Notably, this marks covered entities’ second challenge to HRSA’s 340B rebate pilot, as the same court issued a preliminary injunction on an earlier version of the pilot in December 2025. The pilot is scheduled to begin in January 2027, though if granted, the request could delay implementation as litigation continues.

Maryland

• Governor Moore Offers Support for Bill to Tie PDAB UPLs to Medicare MFPs. Last Wednesday, Governor Wes Moore (D) stated he would sign upcoming proposed legislation authorizing the Maryland Prescription Drug Affordability Board (PDAB) to expedite cost review and upper payment limits (UPLs) for drugs with Medicare Maximum Fair Prices (MFPs). The proposal comes from the Maryland Healthcare for All Coalition, which sent letters to House and Senate candidates asking whether they would support the measure. Generally, a Maryland bill needs votes from 71 House members and 24 senators to pass. In the survey, 98 House candidates, including 79 incumbents, and 29 Senate candidates, including 26 incumbents, indicated they would support the measure. So far, the PDAB has voted to set UPLs for Jardiance and Ozempic. Legislators are expected to introduce the bill in January.

Nevada

• Health Authority Releases RFP to Operate PACE Sites. Recently, the Nevada Health Authority (NVHA) released a request for proposals (RFP) to operate Program of All-Inclusive Care for the Elderly (PACE) sites statewide. Through PACE, NVHA aims to expand access to community-based integrated medical, behavioral health, social, and supportive services for adults ages 55 and older who meet a nursing facility level of care and reside in a community. NVHA plans to launch PACE in a scaled approach, seeking to implement the program in both high-density urban areas as well as rural and frontier communities. NVHA intends to award multiple contracts under a risk-based monthly capitation model. Interested bidders may propose sites within one or more designated service areas; contract rates will vary by geographic area and dual eligibility status. NVHA expects contracts to run from June 8, 2027 to December 31, 2032, with optional extensions for an additional four years. Responses are due by December 10, 2026, and the anticipated award notice is on April 30, 2027.

New Hampshire

• Rural EMS and Mobile Health Units Receive $11 million in RHTP Grants. Last Friday, the Centers for Medicare & Medicaid Services (CMS) announced $11 million in Rural Health Transformation Program (RHTP) funding for Mobile Integrated Health programs and rural EMS. The funding aims to expand mobile healthcare programs, increase EMS agencies' and health systems' capacity to meet rising demand and financial pressures amid workforce shortages, and support partnerships among municipalities, EMS agencies, and rural hospitals. This funding represents part of the state’s overall $204 million award for FY 2026, which also focuses on rural healthcare workforce development, advanced care and payment models, and technological improvements for remote care.

New York

• State Department of Health Submits Five-Year Renewal Request for Medicaid Redesign Team Waiver. This past Thursday, the Centers for Medicare & Medicaid Services (CMS) announced that the New York State Department of Health (DOH) submitted a request to renew its Medicaid section 1115 demonstration waiver for the Medicaid Redesign Team. The waiver is currently set to expire in March 2027; if granted, it would be extended through 2032. DOH’s request would extend several programs without changes, including the mainstream and long-term managed care system and enrollment services; behavioral health home and community-based services (BH HCBS) under Community Oriented Recovery and Empowerment (CORE); residential and inpatient substance use disorder treatment; and limited use of Designated State Health Program (DSHP) funding. Additionally, DOH requested to continue authority for the HCBS expansion population, individuals switching from institutional nursing facilities to long-term community services, and medically needy children under the family of one demonstration. DOH also seeks to make minor amendments to the Health-Related Social Needs (HRSN) services and continue limited expenditure authority for workforce initiatives and the health equity regional organization (HERO) initiative. Lastly, DOH proposed discontinuing HRSN infrastructure funding, the Self-Direction Pilot, and BH HCBS services that have not transitioned to CORE. Public comments may be submitted to CMS through November 14, 2026.

Ohio

• Governor DeWine Announces $92 Million to Support Rural Care Access. This past Friday, Governor Mike DeWine (R) announced that the Ohio Department of Health administered $92 million in Rural Health Transformation Program (RHTP) awards for chronic illness management and expanded access to preventive, primary, maternal, and behavioral healthcare. $31.4 million was awarded to establish Clinically Integrated Networks (CINs) and Rural Health Innovation hubs that coordinate care across multiple healthcare providers to deliver cost-effective care. DOH awarded another $30.3 million for maternal health, including mobile prenatal care services, virtual specialty care for pregnant individuals, and premature and medically vulnerable newborn care within rural hospitals. The remaining $30.3 million was given as one-time $1.38 million investments to rural hospitals for various quality improvement projects. These included creating new behavioral health units and adding MRI and diagnostic services. These awards include all of the FY 2026 and part of the FY 2027 funding for the hospital CIN/healthcare innovation hub initiative and build on previous funding rounds for rural healthcare workforce development and rural pharmacy connectivity.

Oregon

• Governor Kotek Issues Executive Order on Preserving Healthcare Access and Primary Care Support. Last Tuesday, Governor Tina Kotek (D) issued an executive order (EO 26-27) focused on supporting health care access, affordability, and primary care providers as the state prepares for Medicaid funding cuts and the loss of extended enhanced healthcare subsidies. The order directs state agencies to take several actions, including:

  • Conducting a third-party analysis of and submitting recommendations for the state’s reinsurance program and health plan network analysis.

  • Enforcing the 12% primary care spending target and implementing timely reimbursement requirements within 60 days.

  • Recommending changes to simplify the Patient Centered Primary Care Health Program and reduce administrative burdens.

  • Optimizing state purchasing of high-cost prescription drugs and drafting a proposal for a unified Medicaid drug formulary.

  • Tracking Medicaid application and renewal denials due to community engagement requirements.

  About 97% of Oregonians have health insurance, a rate the state intends to maintain through the executive order. 

Pennsylvania

• Attorney General Sunday Announces Antitrust Lawsuit Against PBMs and Drug Manufacturers. This past Tuesday, Attorney General Dave Sunday (R) announced a lawsuit against several pharmacy benefit managers (PBMs) and drug manufacturers over alleged antitrust violations. The complaint alleges the defendants conspired to artificially inflate insulin prices by over 1000% through illegal market practices. AG Sunday’s office is alleging violations of Pennsylvania’s Unfair Trade Practices and Consumer Protection Law, and seeking injunctive relief to force structural changes to lower insulin prices, along with restitution for affected consumers and civil penalties.

• Department of Human Services Releases RFI on Medicaid Managed Care Procurement. Recently, the Pennsylvania Department of Human Services (DHS) released a request for information (RFI) on developing the procurement for Physical HealthChoices, the state’s mandatory Medicaid managed care program. DHS proposes that the program focus on poorly controlled chronic conditions, perinatal and child health, and children with complex health needs. The RFI emphasizes program design, community and population health initiatives, health equity and health-related social needs, value-based purchasing and alternative payment models, outcomes-based quality measures and performance standards, community partnerships, IT, and program integrity. Additionally, DHS is considering whether to make plans offer statewide services instead of geographic zone-based offerings, carve in non-emergency medical transportation, and coordinate care between physical health and behavioral health managed care organizations (MCOs). The current incumbents serve approximately 2.3 million Medicaid enrollees. Responses are due to the state by November 20, 2026.

Texas

• Governor Abbott Announces $78 million for Rural Texas Strong Grants. Last Thursday, Governor Greg Abbott (R) announced that the Texas Health and Human Services Commission plans to award $78 million in Rural Health Transformation Program (RHTP) funding through the Rural Texas Strong initiative. These grants, in particular, will support three initiatives:

  • Make Rural Texans Healthy Again: Supports rural hospitals’ services managing chronic diseases such as diabetes, cardiovascular disease, chronic respiratory disease, and obesity.

  • Next Generation of the Small Town Doctor and Team: Supports recruitment, training, and retention for rural physicians, EMS, and other healthcare workforce members. 

  • Infrastructure and Capital Investments for Rural Texas: Supports purchasing medical equipment and rural facility improvements. 

  This funding is a portion of the state’s $281.3 million in first-year RHTP funding. HHSC will continue to release funding announcements on a weekly basis.