Democratic Gov. Kathy Hochul proposed several initiatives Jan. 13 that aim to shore up healthcare in New York state.
Affordability has been a pressing concern among New Yorkers. In the news release, Ms. Hochul said she will direct the state’s Department of Health to negotiate with federal officials over Essential Plan coverage losses affecting 450,000 residents. She also addressed how 140,000 New Yorkers will face a 38% increase in premiums due to the expiration of enhanced ACA subsidies.
Prior authorization reform was another priority for Ms. Hochul. Going into 2026, several states have been focusing on turnaround times for prior authorization decisions. For Ms. Hochul’s initiative, transparency is the cornerstone.
“These reforms will improve access to care by removing unnecessary administrative burdens on providers and making sure critical care is neither delayed nor denied,” the release said.
Here are five proposed prior authorization reforms payers should know:
1. Ms. Hochul said she would require formularies — drug lists that insurers cover — to be publicly available in a “standard, accessible format.”
2. Ms. Hochul also said she aims to extend continuity of care “from 60 days for life-threatening conditions or late-stage pregnancy to 90 days for all health conditions and the full postpartum period.”
3. Prior authorizations addressing certain chronic conditions would have longer validity, according to the governor.
4. Health insurers would be required to share more data on claims processing. Some data points include the frequency claims are subject to prior authorization, as well as the frequency of their denials.
5. New York would launch a public education campaign to support consumers and providers as they face insurance issues.
