Beginning January 1, 2026, several state and federal health laws will take effect, which will bring numerous policy changes related to coverage requirements, preventive health services, and healthcare financing and delivery systems.
Health-related legislation was a major focus of the Arkansas General Assembly’s 2025 regular legislative session, and the state will implement many health-related laws in the new year. These actions from lawmakers are intended to address maternal health care, expand access to preventive health services, strengthen the healthcare workforce, and change how some services are covered and delivered under state-regulated health insurance plans.
Arkansas Health Policy Changes
Act 866 requires health plans, as well as Medicaid and the Arkansas Health and Opportunity for Me (ARHOME) program, to cover deliveries that occur at a licensed birthing center the same as hospital-based deliveries. Arkansas currently does not have a licensed birthing center, but the law establishes coverage requirements if any are licensed in the state in the future. The law is intended to expand delivery options and support alternative models of maternity care.
Act 627 requires health plans — as well as Medicaid, ARKids First, and ARHOME — to cover breastfeeding and lactation consultant services provided in outpatient settings. This coverage is not subject to annual deductibles, copayments, or coinsurance.
Act 390 requires health plans, as well as Medicaid and ARHOME, to cover lung cancer screening and related follow-up services consistent with American Cancer Society guidelines, without imposing additional cost sharing specific to those services.
Insurance coverage for certain genetic and imaging services will also expand beginning January 1. Act 860 requires insurers to cover genetic testing for inherited cancer-related gene mutations when clinically indicated, as well as specified evidence-based cancer imaging for individuals with an increased risk of cancer.
Act 424 defines breast reconstruction surgery for insurance coverage purposes, requiring insurers to cover all stages of reconstruction following trauma, disease, or mastectomy, as well as reconstruction performed to reduce the risk of future breast disease.
Act 628 requires health plans to cover medically necessary treatment for diseases and conditions caused by severe obesity for adults, including bariatric surgery and related care. The law does not require coverage of injectable glucose-lowering drugs and other medications prescribed for weight loss.
U.S. Health Policy Changes
Several federal health policy changes scheduled to take effect on January 1, 2026, will affect coverage affordability, eligibility, and healthcare delivery nationwide.
Changes to federal Health Insurance Marketplace rules will alter how premium tax credits function for some enrollees. The cap on premium tax credit repayments will be removed, increasing the amount that some individuals may be required to repay at tax time if their actual income exceeds projections used to determine subsidy eligibility. This change could increase financial risk for enrollees whose incomes fluctuate during the year.
Eligibility for premium tax credits will also narrow for lawfully present noncitizens. Beginning in January, premium tax credits will no longer be available to lawfully present noncitizens with incomes below 100% of the federal poverty level who are ineligible for Medicaid due to immigration status, including lawful permanent residents subject to the five-year Medicaid waiting period for coverage eligibility.
Medicare-related changes will affect both enrollees and providers. The Centers for Medicare and Medicaid Services will launch the Wasteful and Inappropriate Service Reduction (WISeR) Model, a pilot program that introduces new prior authorization requirements in traditional Medicare. The WISeR Model is set to take effect in January in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
Beginning in 2026, Medicare will apply negotiated drug prices to the first group of Part D drugs selected under the Inflation Reduction Act. The initial list includes 10 high-cost medications for common conditions.
Even with several changes already set to take effect, ongoing discussions at both the state and federal levels will continue to shape policy debates and implementation decisions in the year ahead.
