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SB 464

HEALTH CARE: Provides relative to coverage for severe obesity treatment. (gov sig) (EN NO IMPACT See Note)

2026 Regular Session Introduced by Regina Barrow

Louisiana SB 464 shifts obesity treatment coverage to state-funded actuarial, annual cost estimates and caps, removing ties to the Essential Health Benefits Benchmark Plan.

Effective date 5/29/2026.
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Bill Summary · SB 464

Summary of Louisiana SB 464 (2026 Regular Session)

Title

HEALTH CARE: Provides relative to coverage for severe obesity treatment. (gov sig)

Primary purpose

To reform how health insurance in Louisiana covers treatment for severe obesity. The bill proposes replacing current law with a framework that plans and funding for obesity-related services are determined through actuarial estimates, funding ratios, and explicit caps based on annual calculations. It aims to remove the current tie to the Essential Health Benefits Benchmark Plan and establish a state-directed funding and coverage standard process.

Key provisions and changes

  • Clarifies applicability

    • Repeals the current requirement that coverage for severe obesity treatment be limited to services covered by the Essential Health Benefits Benchmark Plan.

  • Annual actuarial cost estimating (beginning with 2026 for 2028 costs)

    • By August 1 each year, insurers offering “qualified health plans” must submit to the Department of Insurance an actuarial estimate of the cost to provide the obesity-related benefits for calendar year 2028 (and for 2029 onward, per-year updates).
    • The estimate must be prepared by a member of the American Academy of Actuaries and follow generally accepted actuarial principles, including per-member-per-month and population assumptions, as well as aggregate costs.

  • State cost projection and benchmarking (annual)

    • By December 1 each year, the Department of Insurance must publish the estimated cost to defray the state's share of these services, as required by federal law (42 U.S.C. 18031).

  • Funding ratio and minimum coverage standard (annual)

    • By July 1 each year, the Department must notify insurers and health plans of:
    • The funding ratio (state appropriations divided by the estimated cost to defray services).
    • The minimum coverage standard (calculated as the aggregate expected service volumes per member-month multiplied by the funding ratio).

  • Caps on coverage (effective 2028 onward)

    • If the published funding ratio is 1.0 or greater, issuers may not apply a numerical cap on the covered obesity-related services.
    • If the published funding ratio is less than 1.0, issuers may apply a numerical cap no less than the product of the minimum coverage standard and the number of member-months from the most recent plan year (rounded up).
    • Any numerical cap must be clearly stated in the health insurance plan documents and described using the actual numerical cap (not just a formula).

  • Transparency

    • The bill requires clear disclosure of any numerical caps in plan documents.

Who/what is affected

  • Health insurance issuers offering health coverage plans in Louisiana that meet the definition of a “qualified health plan.”
  • Health plans sold in Louisiana that are subject to the coverage requirements for severe obesity treatment.
  • Louisiana Department of Insurance (LDOI) and Louisiana Department of Health (LDH) for cost assessments and benchmarking.
  • Policyholders and enrollees who rely on coverage for severe obesity treatment (including bariatric surgery and associated services).

Procedural and timeline highlights

  • August 1, 2026: First required actuarial cost estimate submitted for 2028 costs (and annually thereafter).
  • December 1, 2026: LDOI to publish estimated state cost to defray services (and annually thereafter).
  • July 1, 2027: LDOI to notify issuers/plans of funding ratio and minimum coverage standard (annually thereafter).
  • January 1, 2028: If funding ratio is >= 1.0, no numerical caps may be applied to obesity-related services (effective for plan years meeting/exceeding 1.0).
  • If funding ratio < 1.0, issuers may apply a numerical cap as described (effective for the applicable plan year).
  • Effective date: Upon the governor’s signature (or constitutional fallback).

Notes

  • The bill’s language emphasizes actuarial rigor and state-level budgeting for severe obesity treatment coverage rather than tying benefits to a federal Essential Health Benefits Benchmark Plan.
  • The bill is labeled (gov sig) and includes mechanisms for ongoing annual reporting and potential caps based on funding sufficiency.

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

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