Minnesota Prior Authorization Law Changes 2026: What Patients and Employers Need to Know

Starting January 1, 2026, Minnesota enacted some of the strongest prior authorization protections in the country. If you have a chronic health condition, need cancer treatment, or receive mental health care, your insurance company now faces significant new limits on when and how it can require prior authorization. These reforms apply to all state-regulated health plans — and for the first time, Medical Assistance and MinnesotaCare are included.

Prior authorization — the requirement that doctors obtain insurer approval before providing certain treatments — has long frustrated patients and physicians alike. A 2024 American Medical Association survey of 1,000 physicians found that doctors complete an average of 39 PA requests per week, spending roughly 13 hours on the process. Among those surveyed, 93% reported that PA delays patient care, and 82% said it sometimes leads patients to abandon treatment entirely.

Minnesota first addressed PA reform in 2020 with transparency and timeline requirements. In May 2024, the legislature passed a sweeping expansion (Laws 2024, Chapter 127, Article 57). Dave Renner, director of advocacy at the Minnesota Medical Association, described the approach to the AMA: “We focused on those services where when there is any kind of a delay there is a problem. It’s a different approach to say: Let’s try to start reducing how often prior auth is being used.”

Those reforms are now in effect. This guide explains every major change, who is affected, and how Minnesota’s new mental health insurance laws for 2026 compare to reforms in other states.

What Changed About Prior Authorization in Minnesota for 2026?

The 2024 legislation made eight major changes to Minnesota’s prior authorization rules, all effective January 1, 2026. Here is a side-by-side comparison of what changed. Each reform addresses a specific frustration that patients and providers experienced under the previous system.

Which Services No Longer Require Prior Authorization?

The 2026 law eliminates prior authorization for four categories of health services entirely. Health plans operating in Minnesota cannot require PA for any of these, regardless of the plan type:

Medications for cancer, mental health, and substance use disorder still require PA, but they must now go through the faster expedited review process (48-hour timeline) rather than the standard 5-day timeline.

What Are the New Approval Timelines?

The 2026 reforms create a two-tier timeline system. Standard PA requests are still decided within 5 business days (7 days maximum). But medication requests for mental health, substance use, and cancer care now follow an expedited track requiring a decision within 48 hours — at least one business day — with a 3-day maximum. That is a 58% reduction from the previous 5-day standard.

The federal CMS rule (CMS-0057-F) also shortened the standard decision timeline from 14 to 7 calendar days for Medicare Advantage, Medicaid managed care, and ACA exchange plans. Together, Minnesota’s state law and the federal rule create overlapping protections: state law is often stronger for state-regulated plans, while the federal rule provides a floor for federal program plans.

Who Do These New Prior Authorization Laws Apply To?

An important limitation: Minnesota’s PA reforms only apply to state-regulated health insurance products. That covers individual market plans purchased through MNsure, fully-insured small and large group employer plans, and — starting in 2026 — Medical Assistance and MinnesotaCare.

Self-insured employer plans, which are governed by federal ERISA law, are generally exempt from state insurance regulations. The Minnesota Medical Association estimates that state-regulated plans represent roughly 40% of Minnesota’s insurance market. If your employer self-funds its health plan (common among larger employers), these state protections may not directly apply, though the separate federal CMS rule introduces its own requirements.

What Do the Chronic Condition Protections Mean in Practice?

Before 2026, a patient with Type 2 diabetes might need to obtain a new prior authorization every six months or every year for the same insulin regimen that had been working effectively. Each time, their doctor would fill out paperwork, wait for a decision, and potentially face delays in care. According to the 2024 AMA survey, 29% of physicians reported that PA requirements led to a serious adverse event for a patient in their care.

Under the new law, once a PA is approved for a chronic condition, that approval remains valid as long as the treatment regimen stays the same. The law defines a chronic condition as any health condition expected to last one year or more that either requires ongoing medical attention to manage effectively or limits activities of daily living.

This covers a wide range of conditions: diabetes, rheumatoid arthritis, multiple sclerosis, Crohn’s disease, asthma, COPD, heart failure, epilepsy, and many others. If your treatment is stable and the accepted standard of care has not changed, your health plan cannot require you to go through the PA process again.

How Do the New Rules Affect Mental Health Coverage?

Minnesota’s 2026 mental health insurance laws represent a significant expansion of protections for behavioral health patients. The reforms introduce a faster PA decision timeline for medications that treat three categories: outpatient mental health conditions, outpatient substance use disorders, and cancer.

Previously, all medication PA requests defaulted to the standard review timeline — up to five business days for a decision, with a seven-day maximum. Starting in 2026, PA requests for medications in these three categories must be processed on an expedited basis: a decision as soon as the patient’s condition requires, but no later than 48 hours with at least one business day included, and a three-day maximum.

Non-medication cancer treatments consistent with NCCN guidelines are exempt from PA entirely. That means treatments such as radiation therapy, surgery for cancer, and other therapeutic procedures cannot require prior authorization at all, though medications still go through the expedited review process.

How Do Minnesota’s Prior Auth Rules Compare to Other States?

Minnesota’s 2026 prior authorization law changes place it among the most aggressive PA reform states in the country. In 2024, ten states passed PA reform legislation. By mid-2025, at least 18 more had taken action, according to Health Affairs. But the scope of reforms varies widely. Here is how Minnesota compares to three other leading reform states:

Sources: AMA state reform tracker; Health Affairs, “Prior Authorization Reform Heats Up,” 2025; state legislative records. Note: Texas enacted the first gold card law in 2021; Wyoming’s 2024 law requires a 90% approval rate over 12 months for gold card eligibility.

Dave Renner of the Minnesota Medical Association explained a key part of the reporting requirement to HealthLeaders Media: “This standardizes the data and allows it to be analyzed. We will have a better understanding of how and when prior authorization is being used and whether that makes sense.”

What Is the Federal CMS Rule Changing Nationally?

Minnesota’s reforms do not operate in isolation. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), finalized in January 2024, imposes complementary federal requirements on Medicare Advantage plans, Medicaid managed care, CHIP programs, and ACA exchange plan issuers (including plans sold through MNsure).

Starting January 1, 2026, impacted federal payers must follow new decision timeframes: 72 hours for expedited (urgent) requests and seven calendar days for standard requests. They must also begin reporting PA metrics and, by March 31, 2026, publicly post data on PA volume, approval rates, denial rates, and average decision timeframes. In 2023, Medicare Advantage insurers denied 3.2 million prior authorization requests — 6.4% of the total — according to KFF analysis.

By January 1, 2027, all impacted payers must implement a FHIR-based Prior Authorization API that allows doctors to electronically determine whether PA is required, submit requests, and receive decisions directly through their electronic health record systems. Minnesota’s state law separately requires health plans to implement this same type of automated PA system by January 1, 2027.

What Is the Prior Authorization Reform Timeline?

What’s Coming Next for Prior Authorization in Minnesota?

The 2025 Minnesota Legislature is considering SF 1739, which would establish a Prior Authorization Commission within the Department of Health. The commission would review the 25 medications with the highest PA denial rates in the state and recommend specific drugs to be permanently exempted from prior authorization requirements.

Under the proposed bill, the Health Commissioner would approve one medication per year for inclusion on a PA-prohibited list, starting August 1, 2027. The commission would include representatives from the Departments of Health and Commerce, the Minnesota Prescription Drug Affordability Board, health care providers, health plans, patients, and pharmacists. The bill was introduced in February 2025 and referred to committee; its status is being tracked during the current session.

At the national level, lawmakers reintroduced the Improving Seniors’ Timely Access to Care Act in May 2025, which would reform PA in Medicare Advantage plans. Additionally, in June 2025, insurance industry leaders made a voluntary pledge to reduce the volume of services subject to PA beginning in 2026 and implement real-time approvals by 2027.

What Should You Do Now?

If you’re a patient with a chronic condition

If your health plan requests a new prior authorization for a treatment you have been receiving for a chronic condition and your treatment has not changed, you have the right to push back. Cite Minn. Stat. § 62M.07 and explain that your PA should not expire under the new law. If your plan does not comply, you can file a complaint with the Minnesota Department of Commerce.

If you’re a patient receiving cancer or mental health treatment

Non-medication cancer treatments consistent with NCCN guidelines should not require PA at all. If your plan is requiring PA for these services, ask your provider to help you assert your rights under the updated law. For medication PA requests, your plan must now decide within 48 hours for mental health, substance use, and cancer medications — if they take longer, that may be a violation.

If you’re an employer

Confirm with your insurance carrier or broker whether your plan is fully insured (subject to state law) or self-insured (subject to federal ERISA). If you offer a fully-insured plan, your carrier should already be complying with the new requirements. If you self-insure, the federal CMS rule still imposes new requirements on your plan’s utilization review organization. The average medical practice completed 43 PA requests per physician per week in 2024, according to the AMA — streamlined PA processes benefit both employers and their employees.

If your PA was denied

You have the right to appeal. Minnesota law requires written appeal procedures for adverse PA determinations. Your health plan must explain the specific clinical reason for a denial and provide information about how to appeal. Under the new law, if your plan denies a PA for a service that should be exempt (like non-medication cancer treatment), you can cite the specific statute and file a complaint with the Minnesota Department of Commerce.

Frequently Asked Questions

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