04 Mar Cancer News You Need: Social Security Benefits, Health Insurance Rules, & More

March 4, 2025

This blog covers the latest news you need about new federal and state legislation, laws, policies, and programs that may impact the cancer community. This month we have information on Social Security benefits, health insurance rules, and more.

National Updates

• The Social Security Fairness Act was signed on January 5, 2025.This law made changes to the Windfall Elimination Provision (WEP) and Government Pension Offset (GPO). Prior to this change, if certain individuals worked at a job at some point in their work history and paid into the Social Security retirement system, and also worked at a job where they received a pension, then their retirement benefits were reduced or eliminated. These workers include teachers, firefighters, and police officers in many states as well as some federal employees. This new law means that now these eligible workers can also receive their full Social Security retirement benefits. These changes go back to January 1, 2024. Contact the Social Security Administration for more information.
• In January, Center for Medicare & Medicaid Services (CMS) finalized a rule with new requirements for specific health insurance companies to streamline the prior authorization process. The rule requires that companies respond to urgent prior authorization requests within 72 hours and non-urgent requests within 7 days. This law also requires companies provide a specific reason for denials of prior authorizations as well as public reporting of prior authorization data.

State Updates

• Pittsburghpassed a law that forbids employers with 5 or more employees from requiring job applicants or current employees who hold valid Pennsylvania medical marijuana cards to take marijuana tests as a condition of employment.
• Illinoisbanned “junk insurance.” Junk insurance plans were short term, limited duration plans that did not have to meet the consumer protections in the Affordable Care Act.
• Minnesotanow requires insurance plans to cover wigs for patients who lose their hair due to a medical condition, including cancer.
• New Yorkis the first state in the country to require health insurers to cover scalp cooling devices to help preserve hair for cancer patients undergoing chemotherapy treatment.
• The Governor of South Carolinaasked federal officials to approve his request to expand Medicaid eligibility for low-income parents who are working, going to school, or volunteering for at least 80 hours each month.
• South Dakotavoters voted to expand Medicaid 3 years ago through a ballot initiative. The South Dakota legislature is currently voting to add a constitutional amendment to the 2026 ballot, asking to be able to end the Medicaid expansion program, if federal funding for the program drops below 90%.
• Vermontis the most recent state to ban co-pay accumulator adjustment programs (CAAPs), where insurance companies do not count that financial assistance toward a patient’s deductible or out-of-pocket maximum. 21 states as well as Puerto Rico and the District of Columbiahave passed laws requiring insurers to count co-pay assistance paid by, or on behalf of, a patient toward their annual deductibles and out-of-pocket maximum. 17 other states have introduced similar legislation. The All Copays Count Coalition has an interactive map .
• IllinoisGovernor J.B. Pritzker signed the Healthcare Protection Act which bans prior authorization requirements for in-patient mental health emergencies.
• VermontGovernor Phil Scott signed a law that eliminates prior authorization for any in-network service ordered by a primary care provider. This law also mandates prompt response times for authorization requests as well as reforms improving the duration of prior authorization approvals.
• New YorkSenate Bill 1267A/Assembly Bill A901A will take effect on January 1, 2026. The law restricts the use of step therapy, including forbidding insurance companies from requiring patients to “try” and fail more than 2 medications, requiring the use of a step therapy drug for more than 30 days or a timeline based on current medical guidelines; and imposing repeat step therapy after approving a prescribed drug unless 365 days have passed since the approval or an evidence-based safety concern exists. The law also requires health insurers and Pharmacy Benefit Managers to accept health care providers’ attestations as evidence that their patients have tried and failed on required drugs
• Vermontalso passed a step therapy reform law. Effective January 2025, it requires specific response times, outlines situations where step therapy is prohibited, and defines situations that require step-therapy exemptions.
• Illinoisalso barred the use of a step therapy.

Stay tuned for more news at the national and state level that may impact the cancer community.

If you are interested in getting more involved in advocate for a policy or law in your state, check out Triage Cancer’s resources on policy and legislative advocacy efforts .

You can also watch the recording of the recent Triage Cancer webinar – Getting Engaged in Cancer Advocacy .

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related  legal and practical issues . Through  events ,  materials , and  resources , Triage Cancer is dedicated to helping people move beyond diagnosis.

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