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HB 550

AN ACT relating to reproductive health services.

2026 Regular Session Introduced by Sarah Stalker

Expands contraception access and coverage across plans, allows pharmacist provision, and strengthens family planning services with federal-compliance safeguards.

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Bill Summary · HB 550

Overview

HB 550 (2026 Regular Session, Kentucky) is a broad reproductive health package that expands and enforces access to contraception, establishes contraceptive coverage requirements in health benefit plans (including state and local government employee plans), creates related rights and enforcement mechanisms, and makes several administrative and regulatory changes. The bill also touches Medicaid, public employee health coverage, and family planning services funding options. Key effective date: January 1, 2027 for most sections.

1) Main purpose and intent

  • Ensure a statutory right for individuals to obtain contraception and to engage in contraception, and a corresponding right for health care providers to supply contraception, information, referrals, and related services.
  • Require health benefit plans to cover a broad set of contraceptive drugs, devices, and related services without most cost-sharing, subject to specific carve-outs and federal constraints.
  • Expand access to contraception through pharmacist-provision, and create a framework for postpartum long-acting reversible contraception (LARC) coverage, OTC contraception coverage, and extended supplies.
  • Align state statutes with federal health care requirements while exploring federal waivers if necessary to maintain or expand coverage and avoid loss of federal funds.
  • Implement family planning program expansion for low-income individuals funded through federal matching (potentially via a waiver/state plan amendment).

2) Key provisions and changes

  • Section 1: Reproductive health rights

    • Defines contraception and contraceptives with examples.
    • Establishes a statutory right to obtain contraception and a corresponding right for providers to supply contraception, referrals, and information.
    • Prohibits laws or regulations that single out contraception or restrict access to contraception.
    • Grants a private right of action and allows the Attorney General to sue entities or localities that violate the section.
    • Courts may award equitable relief and costs/attorney’s fees to prevailing plaintiffs.
    • Actions filed in Circuit Court; no exhaustion of administrative remedies required.
    • Localities or officials violating this section are not immune from litigation.

  • Section 2: Contraceptive coverage in health benefit plans

    • Applies to all health benefit plans under Subtitle 17A of Chapter 304 (with special definitions for health plans at K-12/university levels and for religious employers).
    • Coverage requirements (2)(a):
    • FDA-approved contraceptives (drugs, devices, products), including prescribed, OTC, on-site dispensing, and postpartum LARC.
    • Voluntary sterilization, patient education/counseling, and follow-up services (e.g., side effects management, adherence counseling, device insertion/removal).
    • Expanded protections and requirements (3):
    • Requires coverage of FDA-approved therapeutically equivalent options if applicable.
    • Allow provider-directed substitutions when medically advisable.
    • Permit extended supply coverage (up to 12 months) and reimbursement per unit for extended supplies.
    • Prohibit denial of coverage due to method changes within 12 months.
    • No prescription required to trigger OTC contraceptive coverage.
    • Cost-sharing and restrictions (4):
    • Generally no deductibles/coinsurance/copays for contraceptive coverage, except for high-deductible plans tied to HSAs with minimal cost-sharing.
    • No restrictions/delays on coverage.
    • Dependents receive the same coverage as the enrolled individual.
    • Religious employer exemption (5):
    • Religious employers may opt out of contraceptive coverage; they must notify prospective enrollees about the excluded contraceptives.
    • Non-contraceptive uses (6):
    • Coverage remains for contraceptives prescribed for other health reasons (e.g., cancer risk reduction, menopause symptoms, life-saving contraception).
    • Relationship to federal law: Sections 2, 3, and 4 (post-2027 effective) must be interpreted in light of federal Essential Health Benefits requirements; potential waivers/deferrals if needed to maintain compliance and funding (Sections 13-15 relate to federal waivers and EHB comparison).

  • Section 3: Medicaid and insurance-related adjustments

    • Amends KRS 304.17A-099 to manage cost defrayal and state compliance with federal requirements; allows cost defrayal payments to be used for plan-wide budgeting.

  • Section 4: Public higher education employee benefits (liability, retirement, and health plan integration)

    • Maintains various protections for state employees, including self-insured plans and requirements on enrollment and special enrollment periods for pregnant individuals.
    • Ensures policy alignment with broader health plan reforms.

  • Section 5: Medicaid-related reporting and compliance

    • Requires Medicaid-related entities to comply with specified statutes and reporting requirements.

  • Section 6: Kentucky Children’s Health Insurance Program (KCHIP)

    • Establishes a state child health plan with Title XXI alignment and federal match considerations.
    • Sets eligibility, benefits (including vision and dental), copay prohibitions, and contracting procedures.
    • Ensures public health department participation in preventive services contracting and a competitive contracting framework overseen by the Finance and Administration Cabinet.
    • Requires broad access for KCHIP recipients to dental/eye care; annual reporting on program effectiveness and costs.

  • Section 7: State employee health insurance (KRS 18A.225)

    • Defines eligible employees and voters for state-sponsored health insurance.
    • Outlines bidding, data reporting, and data ownership by the Commonwealth.
    • Establishes required enrollment options, self-insurance possibilities, mail-order drug provisions, and cost-sharing rules.
    • Prohibits abortion coverage with state funds in this program.
    • Sets special enrollment rights for pregnant women.

  • Section 8: Religious freedom protections

    • Reinforces protection against substantial burdens on religious exercise while allowing the act’s provisions to stand.

  • Section 9: Family planning for low-income individuals

    • Creates a pathway to obtain a Medicaid family planning waiver/state plan amendment to fund family planning services for low-income individuals at a 90% federal match.
    • Requires annual reporting on participation, costs, and program effectiveness (abortions, unintended pregnancies, savings, etc.).

  • Section 10: Pharmacist-provided hormonal contraception

    • Authorizes pharmacists to provide hormonal contraception under collaborative care agreements with prescribers, with standard procedures and required training.
    • Pharmacists must provide risk screening, patient education, and a referral to a primary care/women’s health practitioner.
    • Prohibits requiring an appointment with the pharmacist; allows charging an administrative fee in addition to dispensing costs.
    • Maintains existing insurance coverage rules and offers legal immunity for good-faith provision.

  • Section 11-14: Implementation and federal compliance

    • Sections 2, 3, 4, 5, 6, and 7 take effect for plans issued/delivered on or after January 1, 2027 (Section 11).
    • Sections 12-15 outline timing and federal waivers, essential health benefits alignment, and contingencies for federal permission.
    • Section 14 mandates a 90-day review by the Department of Insurance to assess whether any Section 2 requirements go beyond federal essential health benefits, with a potential federal waiver request within 180 days if needed.

  • Section 15: Federal authorization timeline

    • If federal authorization is necessary to implement Sections 5, 6, or 9, the cabinet/department must request within 90 days of effective date and may delay only those provisions with federal approval.

3) Who and what would be affected

  • Individuals with health coverage through state and local government employee plans and eligible dependents.
  • Public postsecondary employees and their dependents.
  • Private and fully insured/self-insured plans offered to public employees (state and local government).
  • Religious employers (with opt-out provisions) and their employees.
  • Medicaid participants and managed care organizations under Kentucky’s Medicaid program.
  • KCHIP-eligible children and families.
  • Pharmacists and prescribers (hormonal contraception provision).
  • Local governments and the Kentucky Department of Insurance, Personnel Cabinet, Finance and Administration Cabinet, and CHFS.

4) Procedural and timeline aspects

  • Effective dates: Many provisions apply to plans issued or delivered on/after January 1, 2027 (Section 11). Other sections (e.g., Sections 5-9, 14-15) involve regulatory actions and federal waivers with timelines tied to federal processes.
  • Administrative regulations: Several sections authorize or require promulgation of regulations under KRS Chapter 13A.
  • Enforcement: The act provides private rights of action and civil remedies, including injunctive relief and attorney’s fees for prevailing plaintiffs.
  • Federal considerations: The bill anticipates potential need for waivers or changes to align with federal Essential Health Benefits and other federal requirements; a Department of Insurance review is mandated to assess whether any Section 2 requirements exceed federal obligations.

Fiscal notes (local government impact):
- Estimated minimal administrative cost impact (+/- 0.05% of premiums) with potential premium increases of ~$0.24–$1.12 per member per month (annual statewide $993,000–$4.6 million).
- Possible increased overall health care costs by $0.20–$1.12 PM (annual statewide $844,000–$4.6 million).
- Potential federal cost defrayal implications if OTC contraception and male sterilization are added outside the state benchmark plan.

Overall, HB 550 significantly broadens contraceptive access, standardizes coverage across plans, empowers pharmacists in contraception provision, and introduces a comprehensive framework for family planning services and related health coverage, while carefully addressing federal compliance considerations.

Compiled from official sources — confirm details with the bill’s official record.

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