2026 Health Policy Leadership Forum

The National Governors Association Center for Best Practices (NGA Center) convened state and territory governors' health policy advisors in Charlotte, North Carolina, July 8-10 for the 2026 Health Policy Leadership Forum. Through a discussion-based format, the forum provided governors' advisors, NGA Partners and invited guests with an opportunity to exchange perspectives, share implementation strategies, and discuss emerging policy challenges shaping state and territorial health systems. Discussions focused on advancing governors' health priorities in a rapidly evolving policy and fiscal environment while highlighting innovative approaches and peer-informed solutions from across the country.

Over three days, several common focus areas emerged across discussions with state and territorial health policy advisors, including:

• Healthcare affordability and cost containment strategies;
• Rural health transformation and strengthening access to care;
• Medicaid financial sustainability, program integrity, and H.R. 1 implementation;
• Advancing public health through Food is Medicine, chronic disease prevention, and the built environment; and
• Leadership transitions, stakeholder engagement, and sustaining long-term policy priorities.

Healthcare Affordability and Cost Containment Strategies

Healthcare affordability remains a priority for governors as rising healthcare costs continue to place pressure on state and territory budgets and influence health system planning. In a discussion with speakers from Arnold Ventures, the Johns Hopkins Institute for Policy Solutions and the National Association of State Budget Officers (NASBO), participants examined health care affordability through a state budget lens, including the major drivers of spending such as hospital and pharmaceutical costs. A second roundtable with speakers from AHIP, PhRMA and the American Hospital Association provided an opportunity for participants to exchange state and territory perspectives on healthcare affordability strategies, including value-based care, prescription drug affordability initiatives, pharmacy benefit manager (PBM) reforms, administrative simplification, patient financial assistance and opportunities to work across the healthcare system to curb costs long-term. Discussions also emphasized the importance of using data and evidence to inform policy decisions, strengthening collaboration across payers, providers and other stakeholders, and investing in upstream strategies that improve health outcomes and help slow long-term healthcare cost growth.

Rural Health Transformation and Access to Care

As states work to implement their Rural Health Transformation Program (RHTP) initiatives and obligate Year 1 funding, rural health and access to care emerged as a central priority throughout the forum. Discussions focused on strengthening rural health systems through workforce development, telehealth and other innovative technology, community-informed planning and cross-sector partnerships. During a session with health policy advisors from Pennsylvania and Utah and a speaker from GSK Vaccines North America, participants explored the evolving landscape of innovative rural health care and shared novel approaches to strengthening rural health infrastructure. Participants highlighted strategies to expand access across rural and frontier communities through hub-and-spoke networks, community paramedicine, and workforce policies that support licensure portability, scope-of-practice flexibility, and alternative provider models.

Medicaid Sustainability, Program Integrity, and H.R.1 Implementation

Medicaid programs continue to face increasing fiscal pressures while states prepare to implement significant federal policy changes under H.R. 1. During a session with speakers from Katch Strategies and the National Council on Aging, participants examined the fiscal and operational considerations shaping Medicaid programs, with conversations focused on maintaining long-term financial sustainability, strengthening program administration and supporting beneficiary access to services. Discussions explored approaches to improving forecasting and data analysis, strengthening provider payment and pharmacy purchasing strategies, expanding home and community-based services, bolstering beneficiary choice and identifying operational efficiencies to support long-term program sustainability.

Building on those discussions, a roundtable with speakers from the Boston Consulting Group and Maximus focused on Medicaid program integrity and implementation of H.R. 1 requirements. Participants highlighted shared challenges across states and territories, including Medicaid budget gaps, growing numbers of high-acuity beneficiaries and constrained administrative capacity amid implementation of H.R. 1 requirements. Conversations also explored strategies to modernize eligibility systems, leverage technology and artificial intelligence, strengthen cross-agency coordination, and improve communication with beneficiaries, legislators, and other stakeholders.

Emerging Public Health Initiatives

States and territories continue to invest in public health strategies that address the underlying factors influencing health outcomes and improve care for priority populations. In a roundtable with the American Heart Association and the West Virginia Bureau for Public Health, participants discussed emerging research and innovative models to improve access to nutritious foods, including how Food is Medicine initiatives intersect with built environment strategies and other public health programs to reduce chronic diseases. Conversations emphasized that Food is Medicine is a targeted health care intervention that is distinct from income-based nutrition assistance programs, such as SNAP and WIC, and highlighted emerging evidence from state nutrition pilots demonstrating reductions in hospitalizations, emergency department utilization and overall healthcare costs.

Participants also engaged in breakout discussions focused on approaches to improving care delivery for older adults, Tribal and Native communities, and maternal and child health populations. Across the sessions, participants highlighted the importance of starting with targeted, evidence-based interventions, leveraging Medicaid and other state investments, strengthening data infrastructure to measure outcomes, and building partnerships across state agencies and community organizations to support long-term implementation.

Leadership Transitions and Sustaining Long-Term Policy Priorities

As governors advance major health policy priorities amid a period of significant leadership transition, participants emphasized the importance of strategic planning, stakeholder engagement and institutionalizing long-term reforms. With 39 gubernatorial elections taking place in 2026, including 18 incumbent governors seeking reelection and 21 incumbent governors who are term-limited or not seeking reelection, advisors discussed the need to build durable policy frameworks that can withstand changes in administration and continue advancing governors' health priorities over time. Across discussions, participants highlighted the value of engaging legislators, state agencies, providers, payers, community organizations, and other stakeholders early to establish shared goals, strengthen communication, and build consensus around major initiatives.

Participants noted that sustaining progress on efforts such as Rural Health Transformation Program implementation and healthcare affordability will require continued cross-sector collaboration, transparent use of data, and proactive communications that reinforce the long-term value of these investments beyond a single administration. Discussions also underscored the importance of documenting institutional knowledge, preparing comprehensive transition plans, and strengthening coordination between outgoing and incoming administrations to support continuity of government and sustain long-term policy priorities.

Looking Ahead

As states and territories continue to navigate evolving health policy priorities, the Health Policy Leadership Forum provided an opportunity for participants to share experiences, identify common challenges and exchange promising practices. With several states preparing for gubernatorial transitions following the 2026 elections, NGA will continue to support governors and their advisors by facilitating peer learning, sharing emerging practices, and fostering cross-sector collaboration to help advance state health priorities. NGA appreciates the many state and territory advisors, partners and invited guests who contributed their expertise throughout the forum.