Changes to Washington state essential health benefits for 2026

October 1, 2025

The state of Washington has made a number of updates to its essential health benefits (EHB) for 2026 which will go into effect on Jan. 1, 2026. The changes affect:

• Acupuncture
• Artificial insemination
• Neuro/rehab/habilitative support
• Hearing instruments and services
• Inpatient donor breast milk

There were two additional new essential health benefits this year for Wash. state which we were already compliant with. These are pediatric dental as well as foot care, which only required minor language updates.

Details on each of the changes are highlighted below.

For small group and individual plans, effective Jan. 1, 2026, there will be no visitation limits set for acupuncture visits. For large group plans the 12-visit limitation will remain in place.

For small group and individual plans, artificial insemination will now be covered. This includes simple preparation such as sperm washing and isolation and placing sperm into the uterus to become pregnant.

Other assisted reproductive technology, such as in vitro fertilization (IVF) and treatment of infertility is NOT included. For large groups, all fertility services, including artificial insemination, remain NOT covered. For ASOs if they have opted in for infertility treatment, artificial insemination coverage will be mandatory and will not have a dollar limit. All other infertility services can continue to have a dollar limit.

This applies to large group, small group and individual plans. Previously there was a limitation in place that stated members could not use their neurodevelopmental therapy benefit and rehabilitation or habilitative service benefits for the same condition concurrently. This limitation has been removed.

Effective Jan. 1, 2026, when someone with a neurodevelopmental diagnosis uses all their neurodevelopmental therapy benefits, they can start charging that same therapy against their rehabilitative benefits and then their habilitative benefits.

For large group, small group and individual plans, beginning in 2026 there will be no dollar limit on benefits for hearing instruments. Going forward, the benefit will be limited to one hearing instrument per ear with hearing loss every 36 months with cost share varying by plan. This includes bone conduction hearing devices.

In 2026 human donor breast milk during inpatient stays will be included as part of maternity benefits for small groups and individual plans.

Large groups are already compliant with this benefit due to a prior mandate so there are no changes.