In This Week’s Update:
- Recent Federal Funding Activities
- How Medicaid Helps Your State
- Executive Order Seeks to Outlaw Gender Affirming Care for Youth
- Addressing Unaffordable Growth in Hospital Commercial Prices
- State updates: CA, CO, IL, MD, MN, NE, NJ, NM, NV, NY, OR & PA
Recent Federal Funding Activities
Last week, there was a lot of activity at the federal level. This article by Manatt Health discusses the status of federal funding and President Trump’s executive orders. Meanwhile, states continue to innovate in order to achieve better, more affordable, and more equitable health for all. The latest post in State Health and Value Strategies’ States of Innovation series highlights state action in January 2025, which included State-Based Marketplaces lifting up their record-breaking open enrollment periods, states moving to protect reproductive health, improve maternal health, address healthcare costs, and more. Updates follow.
How Medicaid Helps Your State
Whether it’s called BadgerCare, Husky Health, Medi-Cal, or something else, Medicaid plays a big role in your state’s healthcare system and economy. With increasing talk of federal cuts to state Medicaid programs, it’s more important than ever to understand the role Medicaid plays in people’s lives, the functioning of state healthcare systems, and state finances. A new interactive map from the Commonwealth Fund provides individual fact sheets, by state, showing the many ways Medicaid is important. The factsheets include crucial information including: who and how many are covered by the state Medicaid and CHIP programs, Medicaid’s importance in rural America, how many young people depend on Medicaid for access to behavioral health services, how many federal dollars each state receives, and more.
Executive Order Seeks to Outlaw Gender Affirming Care for Youth
On January 28, President Trump issued an executive order directing all Executive Branch agencies to work toward shutting off access to gender affirming care nationwide for all children and youth under the age of 19. While the executive order does not immediately change any rules or regulations, it announces as “policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” Such care has already been banned in numerous states, and the executive order is designed to bring the ban nationwide, including in states with laws designed to protect care for transgender children and youth. This executive order follows the Trump Administration’s January 20 executive order asserting there are only two genders, and they are immutable and determined at-birth, and its January 27 executive order directing the U.S. military to change its policies to reflect its claim that transgender individuals are “inconsistent” with military readiness. For a summary of the January 28 executive order, see this Manatt Health article.
Addressing Unaffordable Growth in Hospital Commercial Prices
In recent years, healthcare cost growth has been driven mostly by growth in average prices for healthcare goods and services. A number of states have established healthcare cost growth targets to address this issue, but these programs do not directly hold hospitals accountable for their rising prices. The Milbank Memorial Fund published a new issue brief authored by Bailit Health which outlines seven potential strategies to address high and rapidly rising hospital prices, accompanied by examples from states that have successfully implemented these approaches. The strategies are (1) publishing data on hospital prices and price growth; (2) tying the terms of hospital certificate of need and cost and market impact review approvals to the cost growth target value; (3) taking direct action on narrower hospital pricing policy issues like facility fees; (4) creating a complementary hospital price growth target; (5) setting a hospital price cap; (6) setting a hospital price growth cap; and (7) prospectively reviewing and approving hospital revenue and/or price growth.
State updates: CA, CO, IL, MD, MN, NE, NJ, NM, NV, NY, OR & PA
- California
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- In response to the Southern California wildfires, the Department of Health Care Services (DHCS) received approval of several dozen flexibilities to prevent disruptions in healthcare delivery so Medi-Cal members can continue to receive needed care. Key flexibilities of the 1135 waiver approvals include protections for Medi-Cal members, flexibility in provider enrollment and for home and community-based services, and support for clinics.
- DHCS awarded nearly $65.4 million to 91 organizations to strengthen the California Hub and Spoke System, a model designed to increase access to medications for opioid-use disorder services statewide.
- Colorado – Connect for Health Colorado, the state’s official health insurance Marketplace, announced 282,483 Coloradans have enrolled in health insurance for plan year 2025, a 19% increase than the number who enrolled in 2024. A record 13,968 people enrolled in a health insurance plan through Colorado Connect, with the majority of those enrollments part of the OmniSalud program, Colorado’s program for undocumented individuals. Governor Polis and the Division of Insurance are also highlighting that the record number of Colorado Option enrollments accounted for nearly half of the state’s open enrollment activity.
- Illinois – The Illinois Department of Public Health announced it has awarded $4.5 million to 12 groups across the state funded through Governor JB Pritzker’s 2024 Birth Equity Initiative. The grants, ranging from $100,000 to $700,000, are designed to support innovative, community-based efforts that have the potential to reduce inequities in populations historically at higher risk for adverse birth outcomes. For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.
- Maryland – The Maryland Health Benefit Exchange announced nearly 250,000 Marylanders enrolled for 2025 coverage through the state’s health insurance Marketplace, an increase by 16% from last year. Enrollments by young adults ages 18 through 37 grew 21%, with more than two-thirds of them eligible for Maryland’s young adult subsidy, which the General Assembly will consider making permanent this year.
- Minnesota – The Minnesota Department of Health issued a request for proposal to conduct a legislative study of administrative spending associated with health insurance coverage and the delivery of healthcare services in Minnesota. The study will identify strategies to reduce unproductive administrative expenditures. Solicitation and submission instructions are available on Minnesota’s statewide procurement system, SWIFT, under ID 2000016615. Responses must be received no later than 3:00 p.m. CT, Mar. 4.
- Nebraska
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- The Division of Medicaid and Long-Term Care launched the Prenatal Plus Program, which supports Nebraska Medicaid-eligible pregnant mothers identified by their prenatal healthcare provider as being at risk for negative maternal or infant health outcomes. The program aims to reduce the incidence of low birth weight, pre-term birth, and adverse birth outcomes while addressing lifestyle, behavioral, and nonmedical factors that may impact the health and wellbeing of both mother and child.
- The Nebraska Department of Health and Human Services recently released the Nebraska Vital Statistics Infant Mortality Dashboard. This dashboard includes de-identified aggregate infant mortality data between the years 2005 to 2023 for Nebraska resident infant deaths.
- Nevada – Nevada Health Link, the state’s official health insurance Marketplace, announced it reached a record-setting open enrollment period with over 110,000 Nevadans enrolling in coverage. This year’s enrollment is about a 10% increase from last year.
- New Jersey – The New Jersey Department of Health published a new interactive report illustrating the connections between food insecurity and maternal and infant health challenges, as well as other community conditions that may affect related health outcomes. Using publicly available data, the report shows that maternal and infant health outcomes can be intertwined with the lack of reliable access to healthy foods and other social, environmental, and economic factors that impact a person’s health.
- New Mexico – Governor Michelle Lujan Grisham announced that 26 additional rural healthcare providers will receive a combined $40.6 million from the Rural Health Care Delivery Fund, part of the $46 million allocated during the 2024 legislative session. Last fall, $5.4 million was awarded to four rural healthcare organizations that demonstrated their ability to immediately implement services. The funding supports a range of services statewide, including behavioral health, primary care, and maternal and child healthcare. These investments address rural health providers challenges, including geographic isolation and financial constraints.
- New York – Governor Kathy Hochul announced that $10 million in state funding is available to offer a statewide Youth and Teen Mental Health First Aid program. The State Office of Mental Health will administer the funding to develop a training and certification program that helps New Yorkers identify, understand, and respond to signs of mental illnesses and substance-use disorders in young people who may be experiencing a crisis.
- Oregon – The Oregon Health Authority (OHA) launched an interactive dashboard to track progress toward the outcomes in the Strategic Plan launched in July of 2024. The dashboard details the strategies and measures under five primary goals: transforming behavioral health, strengthening access to affordable care for all, fostering healthy families and environments, achieving healthy Tribal communities, and building OHA’s internal capacity and commitment to eliminate health inequities.
- Pennsylvania – The Pennsylvania Insurance Department (PID) established a new process for pharmacies to challenge a health benefit plan’s designation of a specialty drug, which is a critical protection provided by Act 77 of 2024. This referral process allows PID to ensure that pharmacy benefit managers and health insurers only label medications as specialty drugs when appropriate. This process will promote consistent coverage decisions on specialty drugs and protect Pennsylvanians from excessive costs and delays in receiving critical treatments.