In This Week’s Update:
- Innovations in Vaccine Development and Delivery
- How States Strengthened Their Healthcare Markets in the 2025 Legislative Session
- Implementing Medicaid Work Requirements: A Guide for States
- Monitoring Rural Health Transformation
- Ruling on CMS’ Marketplace Integrity Rule
- State updates: CA, CO, DE, IL, IN, MA, MD, MO, MS, NM, OK, OR, PA, SD, TX & WI
Innovations in Vaccine Development and Delivery
The Princeton Pulse’s second podcast episode, “Innovations in Vaccine Development and Delivery,” highlights scientific discoveries that could boost immunization rates around the world while preparing for the next pandemic. For this episode, Heather H. Howard, director of State Health Values & Strategies (SHVS), was joined by Andrea Graham, a Princeton evolutionary ecologist with strong research interests in immunity, disease ecology, and disease transmission and Janeen Madan Keller, deputy director of global health policy and policy fellow at Center for Global Development. The panel shares exciting advances in the lab, from mRNA technology that can train the immune system to recognize, remember, and precisely target invading pathogens, to pain-free patches that can be administered by community health workers. They also talk about overcoming barriers to access with combination vaccines that reduce the number of injections and medical visits, and other potential game changers that could ensure vaccines reach the people who need them most.
How States Strengthened Their Healthcare Markets in the 2025 Legislative Session
In the first half of 2025, states enacted numerous laws to strengthen their healthcare markets. This issue brief from the Milbank Memorial Fund examines the legislative strategies states are using to confront high healthcare costs, market consolidation, and the role of private equity. It highlights four key themes: enhanced oversight for healthcare transactions, price control mechanisms, public reporting of healthcare equity ownership, and strengthening corporate practice of medicine laws. The brief includes state specific examples such as Washington’s notice requirements for healthcare transactions and Oregon’s law prohibiting physician non-compete agreements.
Implementing Medicaid Work Requirements: A Guide for States Development and Delivery
To support states’ efforts to implement Medicaid work reporting requirements, Code for America published an implementation guide outlining a four-step process for determining an individual’s compliance status for the purposes of Medicaid work requirement eligibility. The guide describes how the four components can be effectively implemented to help reduce harm to people who are eligible and support states in early planning for January 2027.
Monitoring Rural Health Transformation
Last week, SHVS published an expert perspective blog authored by Kody Kinsley, former North Carolina Secretary of Health and Human Services, Rural Health Transformation Program: State Strategies for Lasting Impact. The $50 billion included in H.R.1 for the Rural Health Transformation Program (RHTP) offers an opportunity for states to improve access and transform systems of care for rural communities—but doing so will require both vision and innovation. The expert perspective details key considerations for states as they design their transformation plans to apply for the fund. In addition, SHVS continues to track state activity in preparation for the program. As of today, 22 states have taken steps to prepare to apply for the RHTP.
Ruling on CMS’ Marketplace Integrity Rule
Also last week, SHVS updated its expert perspective blog describing the recent ruling in City of Columbus v. Kennedy, which stayed on a nationwide basis several provisions of the Marketplace Integrity final rule, creating the need for immediate implementation decisions by states. On August 28, the U.S. Department of Justice filed with the Court a notice that it intends to appeal the decision to the Fourth Circuit Court of Appeals.
State updates: CA, CO, DE, IL, IN, MA, MD, MO, MS, NM, OK, OR, PA, SD, TX & WI
- California – The Department of Health Care Services, in collaboration with the University of California, San Francisco, launched a Reproductive Health Hotline (ReproHH), which is a free, confidential clinician-to-clinician consultation phone service for all providers, including Medi-Cal providers, who have questions about sexual and reproductive health. ReproHH is staffed by physicians with specialized expertise in these clinical areas to minimize the need for referrals to specialists, avoid unnecessary treatments, and enhance healthcare outcomes.
- Colorado – Governor Polis signed a number of bills and took executive action to address the billion-dollar budget hole created by H.R.1. Governor Polis signed HB25B-1006, and Colorado Insurance Commissioner Michael Conway released a statement highlighting how the legislation provides temporary funding to reduce catastrophic premium increases. Governor Polis also signed SB25B-002 which ensures that Medicaid enrollees can continue receiving healthcare services from providers like Planned Parenthood and SB25B-005 to reallocate funding to the Colorado health insurance affordability enterprise.
- Delaware – The Governor’s Office is inviting community stakeholders to provide input on how Delaware should direct investments from the Rural Health Transformation Program. The Governor’s office seeks ideas, priorities, and organizational capabilities to guide investment in rural health improvement efforts.
- Illinois
- The Illinois Department of Healthcare and Family Services is seeking feedback and comments on how Rural Health Transformation Program (RHTP) funds can be used to support rural communities to inform the state’s RHTP application.
- Governor JB Pritzker joined the Department of Public Health, Department of Healthcare and Family Services, and healthcare leaders from southern Illinois to discuss the impacts of federal budget cuts on healthcare across rural areas of the state.
- Indiana – The Indiana Family and Social Services Administration and the Indiana Department of Health convened a Rural Health Transformation Working Group to engage stakeholders across the state to identify best use of the funds to meet the objectives of the program.
- Maryland – Governor Wes Moore launched Rural Advancement for Maryland Peers, also known as RAMP—a $1.6 million grant program to help more Marylanders in rural communities access support to address substance-use. Administered through partnership between the Maryland Department of Labor and the Maryland Department of Health, the funds will help expand and strengthen Maryland’s certified peer recovery specialist workforce—individuals with lived experience in recovery who are trained and certified to support people going through recovery.
- Massachusetts – Governor Maura Healey’s Division of Insurance announced that five of the state’s health insurance carriers will return $75.6 million to over 350,000 people covered by individual and small employer plans under the state’s enforcement of state laws. Massachusetts’s medical loss ratio (MLR) requires carriers to spend at least 88% of premiums on healthcare services, and when a carrier’s average MLR over a three-year period falls below the required threshold, it is required to rebate a portion of premium payments to individuals and small employers.
- Mississippi – The Mississippi State Department of Health declared a public health emergency in response to rising infant mortality rates across the state. Mississippi’s 2024 data show the overall infant mortality rate has increased to 9.7 deaths per 1,000 live births, which is the highest in more than a decade.
- Missouri – The Missouri Department of Social Services is seeking public comment on priorities, strategies, and specific opportunities regarding the Rural Health Transformation Program.
- New Mexico – The New Mexico Health Care Authority is seeking a contractor to provide strategic planning, application drafting, stakeholder engagement, federal policy analysis, allocation modeling, and coordination to ensure the timely submission of a comprehensive Rural Health Transformation Program application.
- Oklahoma – The Oklahoma State Department of Health announced that, in collaboration with the Oklahoma Health Care Authority, the Oklahoma Department of Mental Health and Substance Abuse Services, and the Oklahoma Department of Human Services, it is gathering input from those who live in and serve rural communities to help inform the state’s plan for the Rural Health Transformation Program.
- Oregon – The Oregon Health Authority is seeking public comment to inform the state’s strategic approach to applying for and implementing the Rural Health Transformation Program.
- Pennsylvania – Pennie, the state’s official health insurance Marketplace, in coordination with Health Market Connect LLC, the newly appointed contractor of Pennie’s Assister Network, is launching a network of regional organizations dedicated to providing localized support throughout the Commonwealth. The appointed regional organizations will be responsible for hiring local Pennie-Certified Assisters who will serve as trusted guides throughout the enrollment process and conducting outreach to the uninsured.
- Texas
- Governor Greg Abbott signed Texas’ Make America Healthy Again legislation into law alongside U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr. The bills include embedding nutrition education across K-12 schools, higher education, and the healthcare workforce and requiring stronger food label transparency for consumers.
- Governor Greg Abbott and Secretary Robert F. Kennedy Jr. participated in a roundtable with Texas rural healthcare stakeholders, followed by a press conference, to discuss rural healthcare initiatives including the Rural Healthcare Transformation Program and how the state can continue improving rural health outcomes for Texans.
- Wisconsin – Governor Tony Evers released estimates showing H.R.1 will increase costs to Wisconsin taxpayers by over $284 million over a two-year biennial budget cycle, while forcing over 270,000 Wisconsinites to lose their health insurance and tens of thousands of Wisconsinites to lose access to basic food necessities.