Amid shifting federal priorities and tightening budgets, states are increasingly becoming the drivers of health policy and innovation. This panel will explore how state and local leaders are navigating today’s policy landscape to advance public health and health innovation. The discussion will highlight emerging strategies at the intersection of public health leadership, AI, Medicaid/Medicare and local implementation. Panelists will share practical insights on innovation under fiscal constraints, collaboration across sectors, and the growing role of states in shaping the future of health.