Massachusetts' health reform is running on all cylinders with 439,000 previously uninsured now covered in state or private plans. However, 2009 brings new challenges as the state mandates prescription drug coverage for individuals with health coverage and changes the rules on how businesses fund the program. Funding of the program is on solid ground for 2009, but long-term cost controls signed into law by Gov. Deval Patrick won't have time to take hold. In Maine, the troubled Dirigo Health program had another setback when voters on Nov. 4 rejected a funding proposal. Throughout the region, PPOs are making gains while HMOs lag in every state but Massachusetts where two out of three in the commercial marketplace are still enrolled in the more tightly controlled health plan designs. Medicare private fee-for-service plans are likely to survive in parts of the region, despite a new law that requires they convert to a network-based plan. A comprehensive medical home pilot involving all the major payors in Rhode Island is off the ground. And in Massachusetts, a growing number of cities and towns are opting for the Group Insurance Commission program, which means enrollment losses for Blue Cross Blue Shield of Massachusetts.