Health and health care
79 upcoming changes, soonest first.
October 2026 2
Medicare adds wheelchairs, braces and an air bed to its prior approval list
Medicare suppliers need prior approval to deliver eight more items, including an air-fluidized bed, an ultralightweight wheelchair and knee and back braces; 22 more need a face-to-face visit and written order first. Elbow and wrist brace approval starts in four states, then expands.
Social Security rewrites its heart and blood vessel rules for disability claims
Social Security revises its disability listings for heart and blood vessel disorders, adds listings for aortic valve disease, cardiomyopathy and artery disease in transplanted hearts and updates the criteria for heart failure and other conditions. They apply to new and pending adult and child claims.
December 2026 2
Health plans must drop prior authorization for services they approve 90% of the time
Health plans and insurers must report how often they approve each service that needs prior authorization. Regulators then list services approved at least 90% of the time, and plans must stop requiring approval for those. Medi-Cal managed care plans are excluded.
Tampon and pad makers must track lead, arsenic, cadmium and zinc in products
Makers of disposable tampons and pads must keep data on lead, arsenic, cadmium and zinc levels in their products and hand over test results when the state toxics department asks. The department may retest at the maker's cost and add more chemicals.
January 2027 63
AI tools that guide diagnosis or treatment must be checked for bias
Developers of AI systems that help with diagnosis or treatment decisions must make reasonable efforts to find and reduce risks of biased results, and disclose intended uses and risks. Hospitals, clinics and doctors' offices using them must monitor for bias.
Adult care homes get 12 business days instead of 10 to report a new email
Licensees and applicants for adult community care and residential care facilities now have 12 business days, up from 10, to tell the Department of Social Services when their email address of record changes.
Attorney General gains oversight of health plan arbitration clauses
The Attorney General oversees, and can demand reports from, health plans whose contracts require binding arbitration, to check that they follow state disclosure and arbitration rules. Arbitration claims under a health plan must be run under the California Arbitration Act.
Autism service paraprofessionals are covered by the state's telehealth rules
Qualified autism service paraprofessionals are added to the health care providers covered by the Medical Practice Act's telehealth rules, which require providers to tell patients about telehealth and get and document their consent first.
Boric acid vaginal suppositories stay on sale but need a pregnancy warning
Vaginal suppositories with added boric acid must carry a label warning against use when pregnant, trying to conceive or nursing. The state ban on boric acid in cosmetics doesn't reach these products until later, and never does if the FDA regulates them as drugs.
California will match any federal move to loosen testosterone drug controls
Testosterone and dihydrotestosterone stay Schedule III drugs in California. If federal law moves them to a less restrictive schedule or exempts them, state law automatically does the same.
Cancer treatment facilities must post a sign about cancer case reporting
Hospitals and other facilities that treat cancer patients must post a state-designed sign in a visible spot saying cancer cases are reported to the state and may be shared with researchers, with a QR code to the California Cancer Registry.
Clinicians can meet the maternal mental health screening duty by referring patients
Prenatal and postpartum clinicians can meet the maternal mental health screening duty by referring a patient to another licensed practitioner, and must see that anyone who screens positive gets evaluated. Health plans and insurers must give those members case management.
Clinics and hospitals must post signs barring immigration agents without a warrant
Health care providers must now post the notice at main entrances saying immigration agents need a judicial warrant to enter private areas, and must set visitor procedures. Staff must be told how to handle detained patients' requests to tell family where they are.
County mental health directors must set rules for who can order 72-hour holds
County behavioral health directors must set up and carry out procedures for designating and training the professionals who can take a person into custody for a 72-hour mental health evaluation. Before, creating those procedures was optional.
Dental plans must pay out-of-network dentists directly when patients assign benefits
Dental plans and insurers covering out-of-network care must pay a noncontracting dentist directly when the patient signs an assignment of benefits. The dentist must give cost disclosures first and can't charge more upfront than the patient's estimated share. Medi-Cal plans are excluded.
Direct service professionals in disability services renamed direct support professionals
Workers who support people with intellectual and developmental disabilities get a new legal title, direct support professionals. The term now means paid staff of regional center-funded providers who spend at least half their time on direct support tasks.
Disposable tobacco vapes are banned, first from making and importing, then from sale
Making or importing new or refurbished disposable, battery-embedded tobacco vapes for sale in California is banned, and a later ban covers selling or distributing them. Fines start at $500 for a first violation. Cannabis vapes are not covered.
Doctors who surrender licenses during sexual misconduct cases can't get them back
The Medical Board may not reinstate a doctor who gave up a license while a board accusation of sexual misconduct, abuse or exploitation of a patient was pending. Before, the bar covered surrenders made because the doctor committed such acts. Podiatrists are covered too.
Emergency care law doesn't require doctor supervision of nurse-midwives in labor units
Hospital emergency care and health plan payment rules do not require a physician to supervise a licensed nurse-midwife working within their license in labor and delivery, obstetric triage or emergency obstetric units, or when a treating doctor asks them to consult.
Employers that require CPR training must also require naloxone overdose training
Employers that require workers to get CPR certification must also have them take an online naloxone video training approved by the Emergency Medical Services Authority, at the employer's cost. Workers whose CPR or first aid course already meets the standards are covered.
Extra $2 court penalty for emergency medical care funds kept for 10 more years
Counties may keep adding $2 for every $10 of criminal fines to their emergency medical services fund, and 15% of that money still goes to pediatric trauma centers. These rules were set to expire and now continue.
Family members who file CARE Court petitions can give the court information on the patient
The original petitioner in a CARE Court case, such as a parent or spouse, may give information on the person's condition, treatment history and housing, and the court may weigh it. This does not make them a party or give them access to confidential records.
Firms must tell the Attorney General before releasing abortion or gender-affirming care records
California businesses served with a subpoena or similar request about abortion or gender-affirming care must notify the Attorney General at least seven business days before producing records, unless federal law sets a shorter deadline. Requests attesting the case involves conduct illegal in California are exempt.
First responders can ask county mental health agencies to file CARE Court petitions
Instead of filing a CARE Court petition themselves, first responders can ask the county behavioral health agency to file one for a person with severe psychotic illness. The agency must decide within 30 business days and tell the first responder the outcome.
HIV prevention devices and products join drugs in the ban on prior approval by health plans
The ban on prior authorization and step therapy for HIV prevention drugs now covers drug devices and products too, though only one of several equivalent versions must be exempt. Plans issued or renewed must cover provider-given PrEP under both medical and pharmacy benefits.
Health chatbots fall under medical privacy law, and AI can't do licensed clinical work
Businesses offering health care chatbots to consumers are treated as health care providers under California's medical privacy law. Hospitals, clinics and doctors' offices may not let AI independently perform clinical tasks the law reserves for licensed professionals, and must protect clinicians' independent judgment.
Health plans and insurers can't discriminate by race, sex, age or disability
Licensed health plans and insurers may not exclude or discriminate against members based on race, color, national origin, age, disability or sex, including gender identity, sexual orientation, pregnancy and intersex traits. Nor may they deny coverage or claims, or add cost sharing, on those grounds.
Health plans can't cap weekly use of approved autism therapy hours
Health plans and insurers can't restrict when approved autism behavioral therapy hours are used within the six-month authorization, such as weekly caps that make unused hours expire. The hours stay available if their use fits the treatment plan and is documented.
Health plans can't require prior approval for hepatitis C antiviral drugs
Health plans and insurers may no longer require prior authorization for medically necessary direct-acting antiviral drugs that treat hepatitis C. Where equivalent versions exist, a plan only has to cover one version that treats all genotypes without prior approval. Medi-Cal managed care contracts are excluded.
Health plans held to federal mental health parity rules as they stood before recent changes
Health plans and insurance policies must cover mental health and addiction care under federal parity rules and guidance as they stood before recent court challenges, so later federal changes don't loosen them in California. The state's two health coverage regulators must issue joint compliance guidance.
Health plans must also text or email members when a doctor group or hospital leaves
Health plans must send notice that a contract with a medical group or hospital is ending by text or email, as well as mail, to members who opted in. If a deal is reached later, members hear by both routes. Medi-Cal plans are exempt.
Health plans must cover FDA-approved Alzheimer's treatments without step therapy
Health plans and policies issued or renewed from this date, other than Medi-Cal plans, must cover medically necessary FDA-approved treatments for Alzheimer's and other memory conditions. Step therapy is barred, though plans covering one anti-amyloid drug without it may use it for others.
Health plans must cover cervical cancer screening, home test kits included, at no cost
Health plans and insurers must cover cervical cancer screening without cost sharing, including FDA-cleared self-collection home kits, when an in-network provider orders it in line with state public health recommendations. Medi-Cal also covers screening and home kits, if federal approval and funding allow.
Health providers get at least 90 days to fix and resubmit a denied claim
Health plans and insurers must give providers at least 90 days to send a corrected claim after a denial or overpayment notice for a fixable defect. They can't reject the corrected claim for missing another filing deadline, and disputes can go to the plan's dispute process.
Health record companies must turn on privacy protections for abortion and gender care records
Businesses that store medical records on sensitive services for health providers, plans and others must now actually enable the required security features, such as limited user access and separating records on abortion, contraception and gender-affirming care, not only develop the ability to do so.
Home care aides' yearly training must now cover dementia care
The five hours of yearly training home care aides must complete now has to cover the special care needs of clients with dementia, next to topics like client safety and abuse. The minimum hours stay the same, and it can still be done online.
Hospital doctors' competence reviews move from every 2 years to every 3
Hospital medical staff must show they can perform procedures competently when first appointed and at least every 3 years after, instead of every 2. Staff reappointments move from every 1 or 2 years to every 3, and the state may not require them more often.
Hospitals and nursing homes must try to reach next of kin when someone dies
General acute care hospitals and skilled nursing facilities must try within 72 hours to tell known next of kin of a death, then tell the county public administrator within two business days if none is found. Missed notices cost $200 a day, up to $50,000.
Individual and small group insurance must cover fertility care and hearing aids, if approved
If the federal health department approves California's new benchmark plan, individual and small group health insurance policies must cover infertility care, including three retrieval attempts and unlimited embryo transfers, plus wheelchairs, CPAP machines, hearing exams and one hearing aid per ear every three years.
Insulin cost sharing capped at $35 a month in individual and small group plans
Individual and small group health plans and policies can't charge more than $35 in copays, coinsurance or deductibles for a 30-day insulin supply. Where a plan sorts drugs into tiers, the cap covers Tier 1 and Tier 2 insulin. Large group plans already have it.
Insurers must rule within 30 days on prior approval for sole rare disease drugs
Health plans and insurers must finish prior authorization within 30 days of the first request for an FDA-approved rare disease drug that a specialist prescribes as medically necessary, when it is the only FDA-approved treatment for that disease. It applies to new and renewed plans.
Kids' fluoride varnish is covered with no copay, whether billed as dental or medical
Health plans and insurers that cover fluoride varnish for children must cover it with no deductible or copay when medically necessary, whether billed as dental or medical care. Medi-Cal covers fluoride treatment for people under 21, up from 17 and under.
Large group health plans must cover scalp cooling to limit chemotherapy hair loss
Large group health plans and policies issued, amended or renewed under the new rule must cover prescribed scalp cooling to reduce chemotherapy hair loss, with cost sharing no worse than for other cancer supportive care. Medi-Cal adds it if federal funding and approval allow.
Licensed adult drug and alcohol treatment homes must have a suicide prevention plan
Licensed adult residential alcohol and drug recovery facilities must develop a suicide prevention plan, and certified alcohol and drug programs must add one to their operations manual. The state may enforce this through letters until it writes regulations.
Local health officers may track birth conditions and order providers to report them
Local health officers may run programs to track health conditions present in a child's first 12 months and may order providers and labs in their area to report or share records. The records are confidential and barred from use in court, including criminal cases.
Medi-Cal work rule gets more notice and time before anyone loses coverage
Counties must tell enrolled Medi-Cal adults about the work or community engagement rule and check conflicting data with them before denying or ending coverage, and people renewing stay covered through the 30-day period. The state may delay any change until the Legislature funds it.
Minors' conversion therapy ban covers steering toward any orientation or gender identity
Licensed mental health providers may not try to steer a patient under 18 toward a set sexual orientation or gender identity, in either direction, or face discipline. Therapy that explores identity without a set outcome, or that respects the patient's gender identity, is excluded.
Nurse practitioners, midwives and PAs may perform abortions past the first trimester
Nurse practitioners, certified nurse-midwives and physician assistants authorized to perform abortions are no longer limited to the first trimester or to medication and aspiration methods. Nurse practitioners and midwives doing later procedural abortions must keep written plans for handing care to a physician.
Only the authoring doctor may edit a physician's patient notes, with few exceptions
A physician's patient notes, after-visit summaries and treatment plans are that doctor's responsibility and may not be changed by anyone else, except a scribe or assistant acting for the doctor, a doctor who took over care, or a supervising doctor.
Patients must be told a chaperone is available for sensitive ultrasound exams
Providers offering sonographer ultrasounds of the genitals, breasts, rectum or groin must tell patients a medical chaperone is available on request and record when one is present. They must train staff who act as chaperones and can decline the exam without one.
Peer support specialists no longer need a high school diploma for certification
People applying for county peer support specialist certification for Medi-Cal mental health services no longer need a high school diploma or equivalent. The other rules, including being at least 18, stay.
People with serious mental illness leaving jail are presumed eligible for intensive county care
People with serious mental illness who are unsheltered, leaving six months or more in jail, prison or locked treatment, or held five times on psychiatric holds in five years are presumed eligible for full-service partnerships, if a clinician recommends it and space and funding allow.
Pharmacists may swap in biosimilar biologic drugs, and plans may require a cheaper biosimilar
Pharmacists may substitute a biosimilar, not only an interchangeable product, for a prescribed biologic unless the prescriber writes "Do not substitute." Plans and insurers may make a stable patient try a cheaper biosimilar if cost sharing is the same or less, with 60 days' notice.
Pharmacists must tell the prescriber about emergency refills only if one is known
When a pharmacist refills a prescription without the prescriber's approval because the prescriber cannot be reached, the pharmacist now has to notify the prescriber only if a prescriber is identified. Telling the patient is still required.
Plasma centers keep their license through a staff change if they report it quickly
A plasma center's license is no longer automatically revoked when its person in charge of biologics production changes, if the owner tells the state within 5 days and applies within 30. Paid donors may use photo ID from another state, federal agency or tribe.
Prenatal vitamin makers must test for heavy metals and post the results
Makers of prenatal multivitamins sold in California must test every lot for arsenic, cadmium, lead and mercury at a qualified lab. Brand owners must post results by lot online, with a package and web page notice pointing buyers to them.
Prescribed tube-feeding nutrition products can be delivered straight to patients' homes
Pharmacists, manufacturers and wholesalers may deliver enteral nutrition products, medical foods for people who cannot fully use regular food, directly to a patient's home under a valid prescriber order and with pharmacist services.
Shield law for abortion and other protected care now covers patients anywhere
California's limits on arrests, subpoenas and cooperation with other states over legally protected care, such as abortion, now apply wherever the patient is. Police may not arrest someone the Governor refused to extradite, and financial firms must reject out-of-state records demands lacking a sworn statement.
Small group and individual health plans may have to cover fertility care and hearing aids
If federal health officials approve California's new benchmark plan, individual and small group health plans must cover infertility treatment including IVF and egg and embryo storage, plus hearing exams and aids and equipment such as wheelchairs, CPAP machines and hospital beds.
Some health care district hospitals may hire doctors directly
California generally bars hospitals from employing doctors. Health care district hospitals that got a state distressed hospital loan, or that along with their health system have over 75% Medicare and Medi-Cal patients, may now employ physicians and bill for their work if medical staff approve and doctors' judgment is left alone.
Southern California employee benefit group health care pilot extended three years
A pilot letting providers take on financial risk under a large Southern California voluntary employees' beneficiary association now runs three extra years. The state must end it early if reports show serious problems that put enrollees at risk, and file an interim report with recommendations.
State abortion grant program now covers care for veterans whose coverage excludes it
Medi-Cal providers can get state grants for abortion and contraception given free or at reduced cost to veterans whose coverage excludes abortion or who can't get it through the federal veterans health system, with no income limit.
State disease registry adds frontotemporal dementia and runs four more years
The state health department's neurodegenerative disease registry, which requires doctors and hospitals to report cases, now also covers frontotemporal degeneration and other dementias, as long as funds are available. The registry law, which was set to expire, now runs four more years.
State may partner to make a GLP-1 weight-loss drug cheaper, if funded
The state Health and Human Services Agency may enter partnerships to lower prices and ease shortages for at least one FDA-approved GLP-1 obesity drug, if needed and if the Legislature funds it, aiming for a price no higher than its cost to Medi-Cal patients the year before this law passed.
Therapists in prisons and psychiatric hospitals may leave their name off client notices
Therapists, counselors and social workers in psychiatric hospitals and correctional settings may leave their name and license details off the required complaint notice for safety reasons, if their employer allows it and clients have a way to get that information to file a complaint.
Health plans must give cost-sharing estimates by phone and post fuller price files
Health plans and insurers must give members cost-sharing estimates by phone, not only online or on paper. Their public price files add details such as network names, drop unlikely provider rates, are updated less often, and need a contact file.
Medicaid work requirement starts for adults covered under the expansion group
States must require adults 19 to 64 in the Medicaid expansion group to show 80 hours a month of work, community service, a work program or half-time school, or matching income, to get or keep coverage. Exempt groups include parents of children under 14.
March 2027 1
Finance department must propose ways to make big employers pay for workers on Medi-Cal
The Department of Finance must give lawmakers one or more options for making the largest corporations cover the public cost of their employees on Medi-Cal. The duty drops if Congress first repeals the Medicaid parts of federal law HR 1.
April 2027 1
Medicare tests extra drug rebates tied to prices in other wealthy countries
Makers of certain high-spending brand-name Medicare Part B drugs must pay added rebates when U.S. prices top a benchmark drawn from 19 other countries, for patients in the test areas. About a quarter of traditional Medicare patients, picked by ZIP code, pay lower coinsurance on those drugs.
June 2027 1
Medicare accreditors face conflict of interest limits and stricter federal oversight
Groups that accredit Medicare providers may not sell paid consulting to a facility before its first survey, in the 12 months before its next survey, or over a complaint. They must use Medicare's rules as minimum standards and drop terminated providers within 5 business days.
July 2027 4
Hospitals must screen patients for charity care and presume some eligible
Hospitals must screen patients and presume those enrolled in programs such as CalFresh or CalWORKs eligible for charity care or discounts, and must also screen uninsured patients and some others. Hospitals may not require a Medi-Cal or Medicare application first, and patients may opt out.
Medi-Cal autism therapy providers must background check staff who see patients
Medi-Cal providers of behavioral health treatment, such as applied behavior analysis for autism, must run state and national criminal background checks on employees who interact with patients. The state must also seek provider and family input on coverage and billing rules.
Medi-Cal must issue guidance confirming lactation services need no prior approval
The state's Medi-Cal agency must issue guidance spelling out coverage of lactation education, support and clinical consultation, billing codes and health plan duties, and stating these services need no prior authorization, prescription or referral, if federal funding and approval allow.
Patients misled by a wrong provider directory pay only in-network costs
Health plans and insurers must cover care when an enrollee relied on a wrong or misleading provider directory, where before regulators only had the power to order it. Providers may charge only in-network cost sharing, and plans check directories through one state-chosen data hub.
January 2028 4
Large group health plans must cover hearing aids for children and young adults
Large group health plans and policies issued or renewed from this date must cover medically necessary hearing aids and related services for members under 21. Plans may cap coverage at $3,000 per hearing aid.
Tobacco shops must post a lung cancer screening sign at each store
Licensed tobacco retailers must display a free state sign about lung cancer screening, with eligibility rules and the Kick It California quit line, at each location. Stores that don't face a $500 civil penalty per offense.
UC and Cal State health centers must advertise their medication abortion services
UC and Cal State student health centers, which already must offer medication abortion, must promote it, inform students and post it on their websites. Community colleges with health centers must offer access and do the same later, only if the Legislature funds it.
Unlicensed people can't offer osteopathic manipulation or call themselves osteopaths
People without a California osteopathic license can no longer give osteopathic manipulative treatment under the exception for alternative healers who make disclosures. Using 'D.O.' or 'doctor of osteopathy', or implying they are a licensed osteopath, becomes a misdemeanor.
May 2028 1
Health plans and insurers must accept medical records for claims electronically
Health plans and insurers must accept medical records for claims through a standard electronic method, with a file size limit big enough for typical records. They may not deny, pend or delay a claim only because their systems can't take the documents.