Wisconsin Assembly Bill AB263

Wisconsin 2025-2026 Regular Session

• Introduced: 5/19/25
• Refer: 5/19/25
• Report Pass: 1/21/26
• Refer: 1/21/26
• Refer: 2/12/26
• Refer: 2/18/26
• Failed: 3/23/26

Caption

An Act to renumber 632.895 (8) (a) 1.; to renumber and amend 632.895 (8) (d); to amend 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 609.80; to create 49.46 (2) (b) 6. n., 632.895 (8) (a) 1b., 632.895 (8) (a) 1f., 632.895 (8) (a) 1k., 632.895 (8) (a) 1p., 632.895 (8) (a) 1s., 632.895 (8) (a) 1w., 632.895 (8) (a) 5., 632.895 (8) (a) 6., 632.895 (8) (am), 632.895 (8) (d) 2. and 632.895 (8) (d) 3. of the statutes; Relating to: coverage of breast cancer screenings by the Medical Assistance program and health insurance policies and plans. (FE)

Summary

AB263 would expand Wisconsin health coverage requirements for breast cancer screening and diagnostic services. It requires disability insurance policies, self-insured health plans, and certain public employee plans to cover diagnostic breast examinations and supplemental breast screening examinations for people at increased risk of breast cancer or who have heterogeneously or extremely dense breast tissue. The bill defines several imaging terms, including breast MRI, tomosynthesis, ultrasound, contrast-enhanced mammography, diagnostic mammography, and the new categories of diagnostic and supplemental breast examinations, and ties coverage determinations to the most recent applicable National Comprehensive Cancer Network guidelines. The bill also requires the state Medical Assistance program to cover these breast screenings. It preserves current mammography coverage rules while adding the new screening and diagnostic benefits, and it generally prohibits cost-sharing for the new covered services. An exception is included so the no-cost-sharing requirement does not apply if doing so would jeopardize a health savings account-qualified high deductible health plan under federal tax rules. In practical terms, AB263 would amend multiple sections of Wisconsin statutes governing private insurance, Medicaid, and self-insured public plans, including plans for state, municipal, and school employees. It would also explicitly bring preferred provider plans and defined network plans within the mammography coverage framework. The bill takes effect four months after publication, with delayed applicability for policies and plans that conflict with the new requirements and special timing rules for collective bargaining agreements. The overall sentiment in the available record appears supportive, with the bill introduced by a large bipartisan group of Assembly and Senate coauthors. However, there is no committee transcript or recorded vote history in the provided materials, and the bill ultimately failed to pass pursuant to Senate Joint Resolution 1. That means there is no direct discussion record here showing detailed support or opposition arguments, but the broad sponsorship suggests the proposal was framed as a preventive health coverage measure rather than a partisan policy change. The main likely point of contention is the insurance mandate itself, especially the requirement to cover supplemental screening without cost-sharing and the resulting fiscal or premium impact on insurers, employers, and public plans. The bill also notes that it may trigger a social and financial impact report under Wisconsin law, indicating possible concern about mandated-benefit costs. Another possible issue is the interaction with federal HSA-qualified high deductible plans, which the bill addresses by limiting when the no-cost-sharing rule applies.

Impact

AB263 would expand Wisconsin insurance and Medicaid coverage mandates by adding required benefits for diagnostic breast examinations and supplemental breast cancer screening for higher-risk individuals and those with dense breast tissue. It amends statutes governing disability insurance policies, self-insured governmental and school plans, and Medical Assistance, while also clarifying mammography coverage rules and defining new imaging-related terms. The bill would generally prohibit cost-sharing for the new services, subject to a federal HSA-related exception, and would apply prospectively to future policy and plan years.

Sentiment

The available context suggests generally favorable sentiment toward the bill, reflected in its broad bipartisan authorship and cosponsorship. The measure appears to have been presented as a preventive care and access-to-screening proposal. At the same time, the bill’s mandate structure and possible cost implications likely limited consensus, and it ultimately did not become law, failing to pass pursuant to Senate Joint Resolution 1.

Contention

The most notable point of contention is the creation of an insurance and Medicaid mandate requiring coverage of supplemental breast screenings and diagnostic exams without cost-sharing. Insurers, employers, and public plan sponsors could object to increased costs, administrative complexity, or premium impacts, which is why the bill flags a possible social and financial impact report. A secondary issue is the interaction with federal health savings account rules, requiring a carve-out for HSA-qualified high deductible plans. No committee transcript is provided, so specific arguments from supporters or opponents are not available.