In This Week’s Update:
- Open Enrollment 2025 Communications Toolkit: Spanish Translations
- Factors Driving 2026 Individual Market Premium Changes
- Implementing High-Quality Primary Care: A Policy Menu for States
- Expanding Access to Catastrophic Plans
- Resources for Reconciliation Implementation
- More on the Rural Health Transformation Program
- State updates: CA, CO, HI, LA, MA, ME, MI, NH, NJ, NM, NY, OR, PA, VA, WA & WY
Open Enrollment 2025 Communications Toolkit: Spanish Translations
Last week, State Health & Value Strategies (SHVS) published Spanish translations of its 2025 open enrollment communications toolkit. As open enrollment approaches, health insurance Marketplaces face a rapidly shifting policy environment. These changes will influence the way Marketplaces engage with enrollees, community partners, and stakeholders. This toolkit is designed to help State-Based Marketplaces maintain trust with enrollees and stakeholders; communicate clearly and effectively; prepare enrollees for upcoming changes; and help enrollees maintain coverage and access care. The toolkit components can also be accessed through the SHVS Social Press Kit where states can download materials, copy and customize the language to fit their voice and policy context, and incorporate the resources into their communications efforts.
Factors Driving 2026 Individual Market Premium Changes
In August, a group of 16 U.S. Senators asked the Georgetown University Center on Health Insurance Reforms (CHIR) to review the materials health insurers have submitted to state regulators to support their requested rate changes and analyze how policymakers and Americans should prepare for the changes indicated by the filings. CHIR submitted the findings to the Senators on September 2, 2025. Insurers commonly cited increasing healthcare costs and the expiration of enhanced premium tax credits as key drivers of 2026 rate increases. As the loss of premium tax credit enhancements makes coverage less affordable, insurers expect Marketplace enrollment to decline significantly. Insurers expect a similar dynamic from recent federal policies that create new barriers to Marketplace enrollment, including provisions in H.R.1 and the “Marketplace Integrity” rule.
Implementing High-Quality Primary Care: A Policy Menu for States
Decades of research show that robust primary care not only improves health outcomes but can also help curb costs. A report from the National Academy for State Health Policy and the Milbank Memorial Fund offers state policymakers a menu of policy options to support primary care. The priority areas include: 1) make and keep primary care a top policy priority; 2) pay primary care more and differently; 3) make it easier for people to access their primary care clinician; 4) expand and support the current and future primary care workforce; and 5) build provider capacity to provide patient-centered, whole person care.
Expanding Access to Catastrophic Plans
Last week, CMS announced additional guidance that would expand access to catastrophic plans for consumers on healthcare.gov. Consumers that lose access to tax credits when changes to federal law take effect will qualify for hardship exemptions that would allow them to buy catastrophic plans that are normally reserved for individuals under 30 years of age. SHVS experts are reviewing the policy, so keep an eye out for updates.
Resources on Reconciliation Implementation
Also last week, SHVS published two resources for states as they approach the implementation of H.R.1. A toolkit developed by Manatt Health highlights potential data sources for verifying compliance with work reporting requirements and exemptions for enrollees that states can use to identify data sources that will require new IT builds. Manatt also took on one of the biggest changes to eligibility for health coverage programs in the new law–changes for non-citizens. An expert perspective outlines the changes for state programs and discusses the new challenges that non-citizens will face in accessing care.
More on the Rural Health Transformation Program
Additionally, CMS launched a dedicated webpage featuring information on the Rural Health Transformation Program’s (RHTP) structure, strategic goals, and additional resources to support states in the implementation process. SHVS continues to track state efforts to create a transformation plan and prepare to apply for the RHTP.
State updates: CA, CO, HI, LA, MA, ME, MI, NH, NJ, NM, NY, OR, PA, VA, WA & WY
- California – The California Department of Health Care Access and Information held a kickoff webinar for the RHTP to introduce the purpose and goals of RHTP, outline the types of allowed activities supported through the program, and highlight opportunities for stakeholders to engage and participate.
- Colorado – Governor Jared Polis directed the Colorado Department of Public Health and Environment (CDPHE) to ensure that all Coloradans have access to updated COVID-19 vaccines. CDPHE Executive Director Jill Hunsaker Ryan has issued a public health order, and Chief Medical Officer Dr. Ned Calonge has issued a standing order to allow pharmacists to provide COVID-19 vaccines without individual prescriptions. The Division of Insurance is seeking comments on a draft proposed emergency regulation to require carriers to provide COVID-19 vaccines without cost-sharing as a covered preventive service.
- Louisiana – The Louisiana Department of Health has established a dedicated webpage for the Rural Health Transformation Program. The webpage offers a comprehensive overview of the program’s requirements and presents detailed insights into the state’s rural healthcare landscape.
- Maine – In a letter to Maine’s congressional delegation, Governor Janet Mills warned that failure to extend the tax credit could cause monthly health premiums to increase by as much as 117%. The Bureau of Insurance (BOI) announced it has approved an average rate increase of 23.9% for the individual market and 17.5% for the small employer market. BOI Superintendent Bob Carey authored an op-ed describing how the increase in premiums threatens the coverage gains that the state has made.
- Massachusetts – Governor Maura Healey announced a series of measures to ensure vaccine access. The Division of Insurance and Department of Public Health (DPH) issued a bulletin that requires insurance carriers to continue to cover vaccines recommended by DPH and not rely solely on CDC recommendations. DPH issued a standing order to allow pharmacies to continue to provide COVID vaccines to residents aged five and older and updated its vaccine administration policy to permit the DPH Commissioner to determine which routine vaccines can be administered. Massachusetts is also leading efforts to create a public health collaboration with states in New England and across the Northeast committed to safeguarding public health.
- Michigan – The Michigan Department of Health and Human Services is inviting rural health providers, community partners, Medicaid enrollees, and residents in rural communities to complete a survey that will inform priorities for funding under the RHTP.
- New Hampshire – Governor Kelly Ayotte and Commissioner of Health and Human Services Lori Weaver brought together hospitals, community mental health centers, and other rural healthcare stakeholders at a summit to seek input for the state’s application to the RHTP.
- New Jersey – Governor Phil Murphy announced the allocation of $10.85 million from New Jersey’s Opioid Recovery and Remediation Fund to support ongoing efforts to address the opioid crisis, including recovery and overdose prevention services that meet people where they are and promote long-term recovery.
- New Mexico
- Governor Michelle Lujan Grisham announced that state lawmakers will convene on October 1 for a special legislative session to tackle federal cuts to Medicaid and other services, among other issues. Lawmakers plan to address funding to the Rural Health Care Delivery Fund, making health insurance premiums more affordable in the Marketplace and for those losing Medicaid, and resources for the Health Care Authority as it prepares for Medicaid enrollment changes.
- The New Mexico Department of Health (NMDOH) issued a public health order to ensure all New Mexicans can access the COVID-19 vaccine. NMDOH will work with New Mexico’s Board of Pharmacy to remove potential barriers and ensure access to COVID-19 vaccines at pharmacies across the state.
- New York – Governor Kathy Hochul announced that she signed an executive order that will allow pharmacists to administer COVID vaccines, providing access for all New Yorkers who wish to be vaccinated. The executive order will be in place for at least 30 days while a long-term legislative solution is developed to address access to all vaccines.
- Pennsylvania
- Governor Josh Shapiro called on the State Board of Pharmacy to protect COVID-19 vaccine access. In response, the Board voted to allow pharmacists across the state to follow the vaccine recommendations of other trusted authorities.
- The Pennsylvania Insurance Department (PID) launched an educational tour to prepare Pennsylvanians for significant health insurance premium increases for the upcoming year. PID will host free, in-person educational sessions in communities across the Commonwealth to explain the rate review process and PID’s role in regulating the health insurance market; provide an overview of the factors influencing premiums next year; offer guidance on how to compare plans, costs, and provider networks during open enrollment; and share tools and resources to help Pennsylvanians find coverage.
- Virginia – Governor Glenn Youngkin announced the launch of Virginia’s stakeholder engagement process for the RHTP. Virginia health agencies will engage directly with stakeholders in rural communities to gather input and ensure the plan reflects local needs.
- Wyoming – The Wyoming Department of Health announced it is conducting a series of public meetings to gather input on rural healthcare challenges, strengths, and opportunities to ensure Wyoming’s RHTP proposal reflects the needs of Wyoming’s rural communities.
- California, Hawaii, Oregon, and Washington – Governors in California, Oregon and Washington announced they will launch a West Coast Health Alliance to provide evidence-based unified recommendations to their residents regarding who should receive immunizations and to help ensure the public has access and credible information for confidence in vaccine safety and efficacy. Hawaii subsequently joined the alliance.
- CA, CO, CT, DC, ID, IL, KY, MA, MD, ME, MN, NJ, NM, NY, OR, PA, RI, VA, VT & WA – Leadership from the State-Based Marketplaces submitted a letter to Congress about enhanced premium tax credits.