This bill, titled the Ensuring Kids Have Access to Medically Necessary Dental Care Act, modifies the Children's Health Insurance Program to improve dental coverage for low-income children and pregnant women. It prohibits states from setting lifetime or annual dollar limits on dental benefits for eligible children and pregnant women receiving assistance. Additionally, the law requires states to provide dental-only supplemental coverage to certain children without offering them less favorable terms than those available to children receiving full dental benefits. These changes take effect six months after the bill is enacted.
The Alzheimer's Early Detection Act of 2026 requires private health insurance plans and Medicaid programs to cover specific tests that detect biological markers for Alzheimer's disease. These tests, which can be performed on blood or tissue samples, are intended to help with early detection, diagnosis, and treatment management of the condition. The law mandates that insurers treat these tests like other standard medical benefits, meaning patients cannot face higher costs, separate waiting periods, or step therapy hurdles specifically for this care. Additionally, the bill requires insurance companies to approve requests for these tests within 72 hours and directs the National Institutes of Health to study the value of such testing over three years.
The MediKids Act expands Medicaid eligibility to cover children and young adults up to age 26, regardless of their immigration status, and establishes a system for automatic enrollment of newborns that allows parents to opt out if other qualifying health coverage is available. The bill ensures that states provide full federal funding for these expanded groups and extends specific pediatric health services, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), to individuals up to age 26. Additionally, the legislation modifies tax rules to prevent this new Medicaid coverage from counting as minimum essential coverage for the purpose of individual health insurance tax penalties.
The Cancer Drug Parity Act of 2026 requires group health plans and insurance coverage to treat the cost-sharing for oral cancer medications no less favorably than that for intravenously administered cancer drugs. This rule applies to FDA-approved oral cancer treatments that a treating physician deems medically necessary and clinically appropriate, ensuring that deductibles, copayments, and coinsurance rates are not higher for oral options. The legislation also prohibits plans from making changes that would increase out-of-pocket costs or impose stricter limitations on oral cancer drugs compared to injected ones, while still allowing for standard utilization controls like prior authorization. Additionally, the bill mandates a Government Accountability Office study within two years to assess the impact of these changes on patient costs and access.
This bill requires health insurance policies in Pennsylvania to cover at least two epinephrine delivery systems, such as EpiPens, for an annual maximum cost of $35 regardless of deductibles or copayments. It applies to standard medical insurance plans but excludes limited coverage types like dental-only or accident policies. Additionally, the state Insurance Department must investigate manufacturer pricing practices and submit a public report with recommendations to control costs within one year. Insurance companies are also permitted to offer lower out-of-pocket costs than the $35 cap if they choose.
To enact section 3902.78 of the Revised Code to prohibit a health plan issuer from imposing restrictions on pharmacy services that increase transparency and prescription drug access for patients.
Requires insurance policies to provide coverage for federal food and drug administration approved expanded access to an investigational medical product that has been shown to be effective, without the need for any prior authorization determination.
This bill requires health insurance policies that cover hospital, surgical, medical, or major medical services to include screening for Cytomegalovirus for pregnant individuals. It directly affects insurance companies by mandating that their plans provide this specific coverage starting January 1, 2027, for any policies issued, renewed, or modified on or after that date. The legislation ensures that pregnant people can access testing for this virus as part of their standard medical benefits without needing to pay extra out of pocket.
This bill requires health insurance plans in Michigan to count payments made by patients or on their behalf toward out-of-pocket maximums and cost-sharing requirements for prescription drugs. The rule applies to both standard plans and high-deductible plans, with a specific exception for high-deductible plans where counting such payments would disqualify a patient's health savings account. The legislation takes effect for policies delivered, issued, or renewed in the state after December 31, 2025.
This bill requires health insurance policies in Michigan to cover the diagnosis, treatment, and prevention of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. It mandates that insurers provide these benefits without higher copayments or deductibles than other covered services and prohibits denying coverage based on a patient's medical history or previous use of different diagnostic names. Additionally, the legislation sets specific rules for timely authorization, limits on lifetime coverage, and the use of standardized medical codes for billing purposes.
