The Ticker

Appoints Amanda Crawford as the new state insurance commissioner, replacing Cassie Brown, who retired on Feb. 2. Crawford has nearly a quarter-century of public service experience, including as Texas general counsel and deputy attorney general, executive director of the Texas Department of Information Resources, and Texas chief information officer. Brown had served as commissioner since Sept. 7, 2021, appointed by Gov. Greg Abbott (R). Prior to assuming the position, Brown was commissioner of workers compensation at the Department of Insurance from 2018.

Establishes new requirements for Medicare Advantage plans in Oklahoma through an executive order by Gov. Kevin Stitt (R). Among other consumer protection requirements, the order mandates that as of Jan. 22, 2026, no plan shall impose new prior authorization or medical necessity requirements stricter than traditional Medicare; that all plans pay clean claims within 14 days of the date the claim is received; and that all Medicare Advantage plans maintain provider networks that adhere to either Centers for Medicare & Medicaid Services network requirements or network adequacy requirements as established by the Oklahoma Insurance Department (OID), whichever is more stringent. Medicare Advantage plans also must provide annual reports on solvency, network adequacy, and market conduct to the OID.

Will consider at the Feb. 27 meeting of the Ohio Bureau of Workers’ Compensation the additional 1% reduction in statewide workers compensation rates proposed by Gov. Mike DeWine (R). Ohio workers compensation rates have decreased 16 separate times in the past 18 years and fell by 50% since 2019 alone, according to the Ohio BWC.

Issues orders on Jan. 12, 2026, repealing bulletins 2018-013 and 2022-004. Bulletin 2018-013 prohibited adding coverage exclusions for gender identity or gender dysphoria-related treatment, as well as using an insured’s actual or perceived gender identity as a preexisting condition to limit and/or deny health coverage or a claim, among other discriminatory practices, per the New Mexico Department of Insurance’s interpretation of the Affordable Care Act, the New Mexico Human Rights Act, and the New Mexico Insurance Code. Bulletin 2022-004 barred carriers from employing health plan commission structures that would pay different commissions based on the plan’s metal tier and/or not pay commissions at all on certain plans or during certain special enrollment periods. According to the New Mexico DOI at the time, “Discouraging the sale of plans to minimize carrier risk constitutes an implicit additional rule of eligibility” and is an “unfair method of competition, or unfair or deceptive act or practice,” both contrary to New Mexico law.

Updates state regulations to eliminate the requirement for prior authorization from insurance companies for a broad scope of healthcare, encompassing emergency and urgent care, primary care, chronic care, occupational and physical therapy, and select prescription drugs. Specific revisions include freeing diabetes patients from requiring prior authorization for services, devices, and medications related to treatment; giving rheumatoid arthritis patients a three-month window after changing insurers under which their current prior authorization will be sustained;and mandating that insurers reply within 24 hours to a prior authorization request from a multiple sclerosis patient who is relapsing and needs steroid injections to prevent permanent nerve damage. The state also established a Health Care Affordability Working Group to identify cost savings opportunities in healthcare.

Fines 11 insurers almost $25 million for breaches of the state Mental Health Parity Act. The law mandates that insurance companies offer mental health and substance abuse disorder coverage in line with their physical health coverage. Following a yearlong study period in 2022, the state found that the following insurers failed to meet that directive, according to orders issued in January by Insurance Commissioner John King: Aetna, Alliant, Blue Cross Blue Shield Healthcare Plan of Georgia, CareSource Georgia, Cigna, Humana, Kaiser Foundation Health Plan of Georgia, Kaiser Permanente, Nippon Life Insurance Co. of America, Oscar Health Plan of Georgia, and UnitedHealthcare. Cited issues included excessive prior authorization requirements, systemic denial of claims for treating patients with autism spectrum disorder, and making it harder to access covered mental health services compared to medical surgical services. Along with the financial penalties, companies are required to halt any such activities and to provide the state with corrective action plans.

Nine pieces of legislation sponsored by the state Department of Insurance become law in 2026. They include: AB 888, which creates a grant program to support purchases of new or replacement fire-safe roofs, along with steps to reduce fire risks within 5 feet of residences; SB 429, which authorizes the department to provide grant funding for the first wildfire loss catastrophe model to be released to the U.S. public; SB 495, which mandates that insurers cover 60% of content coverage limits without needing a comprehensive inventory from people who lose everything in a wildfire, along with setting a minimum 100-day window for consumers to submit proof of loss to insurers after a formal state of emergency; and AB 226, which enables the state FAIR Plan, with approval from the insurance commissioner, to obtain catastrophe bonds via the California Infrastructure and Economic Development Bank and to establish lines of credit or loan agreements with lenders.