Upcoming Legislative Changes in Health Insurance for 2026

Starting January 1, 2026, significant legislative amendments at both state and federal levels will transform health insurance policies related to coverage specifics, preventive services, and healthcare financing mechanisms. This shift aims to enhance regulatory compliance requirements and improve healthcare delivery standards.

State-Level Changes in Arkansas

In Arkansas, the 2025 legislative session introduced several health-focused statutes to overhaul maternal healthcare and broaden access to preventive services. Additionally, it aims to fortify the healthcare workforce and modify coverage for state-regulated health insurance plans. Key legislative actions include:

Act 866: Mandates health plans, Medicaid, and the ARHOME program to offer equivalent coverage for deliveries at licensed birthing centers as at hospitals. While no licensed birthing centers currently exist in Arkansas, the law outlines coverage parameters should such facilities emerge, addressing both payer and provider obligations.

Act 627: Offers mandatory coverage for outpatient breastfeeding and lactation consultation services, removing these from annual deductibles, copayments, or coinsurance for health plans, aiming to streamline regulatory compliance.

Act 390: Aligns lung cancer screenings and follow-up services with American Cancer Society guidelines, ensuring these services are included in plans without extra cost-sharing, reinforcing provider-payer transparency.

Upcoming Coverage Extensions

From January 2026, additional coverage will include select genetic and imaging services:

Act 860: Requires insurers to cover clinically indicated genetic testing for cancer-related mutations and evidence-based imaging for individuals at heightened cancer risk, enhancing risk management strategies.

Act 424: Expands insurance coverage to encompass all phases of breast reconstruction post-trauma, disease, or mastectomy, ensuring comprehensive provider services.

Act 628: Mandates coverage for treatments of severe obesity-related conditions, including bariatric surgery, although it excludes injectable glucose-lowering medications, improving underwriting practices.

Federal Policy Adjustments

Nationally, federal policy changes set for January 1, 2026, will impact coverage affordability, eligibility, and healthcare service provision. These include significant alterations to the Federal Health Insurance Marketplace and premium tax credit functions, essential for maintaining insurance carrier stability.

The introduction of the WISeR Model in six states heralds new AI-driven prior authorization delays designed to curb wasteful spending. Additionally, negotiated drug pricing for selected high-cost Part D medications will commence under the Inflation Reduction Act, aiming to alleviate payer burdens and reinforce regulatory compliance.

These legislative changes are poised to reshape aspects of the insurance landscape, with ongoing dialogues expected to refine policy approaches and execution strategies moving forward. The insurance industry will need to remain adaptive to these regulatory shifts to effectively manage risk and maintain service quality.