28 Jul Cancer News You Need: Changes to State Laws on Prior Authorization, Paid Leave, & More
July 28, 2026 ~ This blog covers the latest federal and state legislation, laws, policies, and programs that may impact the cancer community. This month, we have information about prior authorization protections; access to cancer screenings, biomarker testing, and fertility preservation; Medicaid; paid family and medical leave; and more.
What Is Happening With Prior Authorization Protections?
Starting June 5, 2026, new regulations in Massachusetts will remove prior authorization requirements for routine and essential health care, including emergency and urgent care, primary care, preventive services, radiology imaging after a cancer diagnosis, and medications for serious mental illness and certain chronic conditions.
The new Massachusetts rules also require insurers to:
- Respond to urgent requests within 24 hours, when a delay could seriously impact a person’s health.
- Honor a prior authorization for the duration of treatment for people with chronic conditions, including cancer, as long as their condition remains stable.
- Honor existing prior authorizations for at least 90 days when a person switches insurance plans.
- Publicly post prior authorization requirements and notify health care providers before changing their policies.
These rules will not apply to:
- Self-insured employer plans, in which the employer pays health care claims directly.
- MassHealth.
- Medicare.
- The Group Insurance Commission, which covers certain public employees, retirees, and their families.
Iowa also passed a new law that will remove prior authorization requirements for certain cancer services. These services include cancer-related screenings and preventive services recommended by a person’s health care professional. The recommendation must be based on the latest National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.
The Iowa law will apply to plans starting January 1, 2027.
What Is Happening With Coverage for Cancer Screenings?
Beginning January 1, 2027, a new Arizona law will require insurers to cover certain follow-up breast cancer screenings without cost-sharing. These screenings include:
- MRIs.
- Ultrasounds.
- Diagnostic mammograms.
Without cost-sharing means that a person will not have to pay a deductible, copayment, coinsurance, or similar out-of-pocket cost for these screenings.
As of July 1, 2026, Hawaii requires health plans to cover colorectal cancer screenings without cost-sharing. This protection includes follow-up colonoscopies.
Hawaii will also provide funding for colorectal cancer screenings for residents who are uninsured or underinsured. The state will provide treatment coverage for uninsured people who are diagnosed with colorectal cancer.
What Is Happening With Coverage for Biomarker Testing?
Illinois passed a law that expands the types of evidence that may be used to show that biomarker testing is medically necessary.
Under the new Illinois law, the following sources may be considered:
- Medicare Local Coverage Determinations.
- Nationally recognized clinical practice guidelines.
- Expert consensus statements.
These sources may be used in addition to evidence that was already accepted.
This change may help make coverage decisions more consistent across different types of health insurance. It also allows insurers to consider expert evidence that may not appear in a clinical practice guideline.
The law will take effect on January 1, 2028.
What Is Happening With Fertility Preservation?
After years of advocacy efforts, Hawaii passed a law requiring state-regulated health insurers to cover standard fertility preservation services.
The law applies when a person receives medically necessary treatment that may harm their fertility. Fertility preservation may include procedures to save eggs, sperm, embryos, or reproductive tissue before treatment begins.
The requirement will apply to plans issued or renewed after December 31, 2026.
The law will not apply to health plans that are not regulated by the state, including:
- Medicare.
- Medicaid, known as QUEST in Hawaii.
- TRICARE.
- The Federal Employees Health Benefits Program.
- Self-insured employer plans, in which the employer pays health care claims directly.
People with these types of coverage should check their plan documents or contact their plan to learn whether fertility preservation services are covered.
What Is Happening With Retroactive Medicaid?
When a person applies for Medicaid and is approved, Medicaid may pay certain medical bills from before the application date. This is called retroactive coverage.
Depending on the state, Medicaid may currently cover eligible medical expenses from as many as 90 days before the application.
The One Big Beautiful Bill Act passed last year limits this retroactive coverage to:
- One month for people covered through Medicaid Expansion.
- Two months for all other Medicaid beneficiaries.
These new limits will apply in all states starting January 1, 2027.
Some states are considering additional limits. Iowa plans to ask the federal government for permission to end retroactive Medicaid coverage for most people enrolled in the program.
This type of request is called a waiver. A waiver allows a state to ask the federal government for permission to operate part of its Medicaid program differently.
Under Iowa’s proposal, pregnant people and children would continue to have access to retroactive coverage.
What Is Happening With State Paid Family and Medical Leave Programs?
Virginia passed legislation in April to create a Paid Family and Medical Leave program administered by the Virginia Employment Commission.
The program will provide eligible employees with up to 12 weeks of job protection and paid time off to:
- Recover from a serious health condition.
- Care for a family member with a serious health condition.
- Address certain other qualifying life events.
Payroll contributions will begin on April 1, 2028, and benefits will become available on December 1, 2028. Most Virginia workers will be eligible, and self-employed individuals may opt in.
Benefits are expected to replace approximately 80% of an employee’s weekly wages, up to 100% of the statewide average weekly wage.
Maine’s Paid Family and Medical Leave program began on May 1, 2026. Eligible employees may take up to 12 weeks of paid time off for medical, parental, family care, military family, or safe leave. An employee’s job is protected if they have worked for their employer for at least 120 consecutive days. Most Maine employees are covered, and self-employed individuals may opt in.
Other state programs to keep in mind:
- Delaware Paid Leave and Minnesota Paid Leave took full effect on January 1, 2026.
- Maryland’s Paid Family and Medical Leave program will begin on January 3, 2028.
What Is Happening With Medical Debt?
Illinois passed a law that prevents hospitals from placing a lien on a person’s primary home because of unpaid medical debt. A lien is a legal claim against property. It may affect a person’s ability to sell or refinance a home.
The Illinois law will take effect on January 1, 2027.
What Else Is Happening in Health Care News?
West Virginia became the third state in the country to require insurers that cover chemotherapy to also cover scalp cooling systems used in connection with chemotherapy. Scalp cooling systems may help reduce hair loss for some people receiving certain types of chemotherapy. This requirement will take effect on January 1, 2027.
In Canada, every province now provides access to job-protected medical leave thanks to new legislation in New Brunswick, the final province to adopt this protection.
About Triage Cancer
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