In This Week’s Update:

• Health Policy Implications of the Federal Government Shutdown
• Expectations for emergency Medicaid Coverage
• States of Innovation: September 2025
• 4.8 Million Will Lose Coverage in 2026 if ePTCs Expire
• Rural Facility and Population Score Estimates by State
• State updates: AK, AR, AZ, CA, IN, KS, MN, MO, MT, NC, NJ, NM, NY, PA & WA

Health Policy Implications of the Federal Government Shutdown
Last week, much of the federal government shut down after Congress failed to agree on annual spending bills. This episode of the podcast ‘What the Health?’ discusses the health policy implications of the shutdown.

States of Innovation: September 2025
SHVS published the latest post in its States of Innovation series, which profiles state activity in September 2025. Throughout the month, states reacted to federal policy by taking action to safeguard health coverage and access to vaccines, as well as to prepare for and apply for the Rural Health Transformation Fund. A significant issue for states in September was the upcoming expiration of the enhanced premium tax credits, and governors and State-Based Marketplace leaders urged Congress to extend Marketplace affordability. Other state action in September included efforts to improve maternal and infant health, mental and behavioral health, and affordability.

4.8 Million Will Lose Coverage in 2026 if ePTCs Expire
An analysis from the Urban Institute finds that 4.8 million people will lose coverage in 2026 if the ePTCs expire. This 21% increase in the uninsured population would disproportionately affect non-Hispanic Black people, non-Hispanic White people, and young adults. 7.3 million fewer people will receive subsidized Marketplace coverage in 2026 if PTCs revert to their standard levels, and eight states, Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas, and West Virginia, would see their subsidized Marketplace enrollment fall by more than half. These estimates only apply to 2026 and future years will see Marketplace enrollment reductions, both with and without ePTCs, because of provisions in  H.R.1 and CMS’ Marketplace Integrity rule.

Rural Facility and Population Score Estimates by State
CMS’ Rural Health Transformation Program Notice of Funding Opportunity (NOFO) defines rural facility and population score factors that will be used in determining the allocation of discretionary funds to states that apply for the fund. The Cecil G. Sheps Center for Health Services Research at the University of North Carolina published score estimates by state as defined by the NOFO.

• Alaska – To help guide its application for the Rural Health Transformation Program (RHTP), the Alaska Department of Health (DOH) asked for public input through a request for information (RFI). DOH received responses from 160 outside groups, including over 400 project ideas and suggestions, and posted an overview of the RFI responses as well as a detailed summary. SHVS continues to track state action to create a transformation plan and prepare to apply for the RHTP. We are also now noting, with links, where states have created dedicated webpages for their RHTP efforts.
• Arkansas – Governor Sarah Huckabee Sanders announced that the state has launched a portal to enable stakeholders to submit proposals in support of the state’s application for the RHTP. In addition, a multidisciplinary team representing the Governor’s Office, the Department of Finance and Administration, the Department of Health, the Department of Human Services, the State Crime Laboratory, and the Office of the Arkansas Surgeon General is coordinating the preparation of the state’s funding application.
• Arizona 
  • Governor Katie Hobbs announced the appointment of Virginia “Ginny” Rountree as the new director of the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program, effective October 6, 2025. Congratulations, Ginny! 
  • AHCCCS announced the launch of Medicaid-covered Traditional Healing services beginning October 1, 2025. Traditional Healing is a system of care deeply rooted in the cultural traditions of Tribal communities and passed down through generations of Tribal healers and knowledge keepers. These practices encompass physical, mental, emotional, and spiritual wellness and may now be reimbursed under Arizona’s Medicaid program through a federally approved section 1115 waiver.
• California – Governor Gavin Newsom signed legislation to protect access to reproductive care and help shield healthcare providers, patients, and lawyers from adverse legal action. AB 260 offers providers the option to prescribe abortion care medication anonymously, ensuring California-regulated health plans cover mifepristone regardless of FDA approval status; and strengthens protections for providers from criminal prosecution and other legal action for administering medication abortion drugs. AB 1525 shields attorneys assisting other states with access to reproductive care from State Bar discipline.
• Indiana – The Indiana Department of Health launched a survey to collect information about ways to improve rural health, to inform the state’s application for the RHTP.
• Kansas – Governor Laura Kelly announced 14 appointments to the Kansas Rural Health Innovation Alliance, a newly created alliance of stakeholders tasked with overseeing the application and implementation of Kansas’ RHTP.
• Minnesota – The Minnesota Department of Commerce announced the finalized rates for plan year 2026, with individual market coverage at a 21.5% rate increase and small group coverage at a 14.2% rate increase. Without the state’s extension of its reinsurance program, the individual market would have faced a 69% rate increase. MNsure, the state’s official health insurance Marketplace, Chief Executive Officer Libby Caulum urged Congress to take swift action to make the enhanced premium tax credits (ePTCs) permanent.
• Missouri – The Missouri Department of Social Services MO HealthNet Division (MHD) convened the inaugural meeting of its MO HealthNet Community Connection (MCC). MCC formally serves as MHD’s Beneficiary Advisory Council. For an update on where states are in implementing their BACs, see this expert perspective from SHVS.  
• Montana – The Department of Public Health and Human Services (DPHHS) hosted a public webinar for healthcare colleagues and community members to discuss the development of Montana’s application for the RHTP. The webinar was followed by an opportunity for public comment, building upon initial feedback DPHHS received from the RHTP request for information.
• New Jersey 
  • The New Jersey Departments of Health (NJDOH) and Human Services (NJDHS) announced their intent to apply for the RHTP and invited stakeholders to share input on the state’s application. Feedback will help identify priorities, gaps, potential partners, and opportunities for improvement, and will guide how New Jersey can best support rural communities across the country in improving healthcare access, quality, and outcomes by transforming the healthcare delivery system. NJDOH and NJDHS will also host a virtual listening session for stakeholder feedback.
  • In a letter to Medicaid providers and managed care organizations, the Department of Human Services Division of Medical Assistance & Health Services clarified that FamilyCare, New Jersey’s Medicaid program, will continue to cover COVID-19 vaccines. 
• New Mexico – Governor Michelle Lujan Grisham issued a proclamation convening a special session of the New Mexico State Legislature on October 1 to address the significant challenges of federal funding cuts resulting from H.R.1, and related federal actions. During the special session, lawmakers will consider measures including the RHTP, health insurance exchange eligibility, vaccine standards, and a response to federal budget cuts.
• New York – NY State of Health, the state’s official health insurance Marketplace, is informing enrollees how they benefit from the American Rescue Plan and Inflation Reduction Act, which provided the enhanced premium tax credits that will expire on December 31. The webpage provides information for different types of enrollees, including those who are currently enrolled, those who started an application but did not enroll, and those who are enrolled but not currently receiving financial assistance.
• North Carolina – The North Carolina Department of Health and Human Services announced standing orders issued by State Health Director Dr. Larry Greenblatt to allow pharmacists at retail locations to test for and treat influenza. Effective October 1, 2025, pharmacists across the state will be able to test for the influenza virus and then immediately treat with the appropriate medications to reduce severity of illness when appropriate as authorized under House Bill 67.
• Pennsylvania – Governor Josh Shapiro signed an executive order that directs the Pennsylvania Department of Health to establish a state-based safety net to protect children’s access to vaccines, requires all state agencies to align policies with trusted medical experts, launches a central online vaccine portal, and creates a Vaccine Education Workgroup to strengthen public communication and combat misinformation. The executive order also ensures continued coverage of recommended vaccines for all Pennsylvanians through Medicaid and private insurance, and directs the Department of Aging and the Department of Education to support older adults and schools in following evidence-based guidance.
• Washington
  • The Washington State Health Care Authority (HCA) asked for public input to help shape the state’s strategy for implementing RHTP. HCA received 285 written responses and shared the common themes on their RHTP webpage. 
  • Governor Bob Ferguson announced an executive order that creates the Immigration Sub-Cabinet, which is tasked with coordinating on immigration and related issues such as data privacy, healthcare, and other programs or services concerning immigrant rights and interests. The executive order also directs state agencies to review their data collection, sharing and retention policies to ensure they are protecting the privacy and safety of all residents consistent with Washington’s values and the law.