A dental procedure includes more than what happens in the chair. Once a patient leaves, the financial path that follows can involve network contracts, negotiated discounts, claim adjustments, payment methods, and in some cases, recoupment. Lawmakers have introduced and enacted dental insurance reforms affecting points in the financial and claim cycle during the 2026 legislative season. 

More than 100 bills have been introduced in 37 states during the 2026 legislative season. According to the American Dental Association’s July 2026 report, 16 states have enacted 30 new laws.¹

The ADA said these bills are a reflection of years of advocacy by state dental associations that work alongside ADA to address concerns related to dental benefit plans.¹

Rather than addressing dental insurance as one issue, the 2026 legislation has introduced bills that specifically target points in the financial relationship between dental practices, insurers, and patients. 

Greater control over network contracts 

Network leasing can determine which contracts and negotiated discounts apply to a dental practice. In 2026, seven states introduced legislation addressing network leasing, with Colorado and Wisconsin enacting new laws.¹ Colorado House Bill 26-1070, the Third-Party Network Agreement for Dental Services, addresses how third-party network contracts are used in the industry. The bill was signed into law by Gov. Jared Polis on April 13 and became effective on August 12.² 

This law requires a dental provider’s consent before an insurance carrier allows a third-party to access the provider’s services and contractually agreed discounts. The law also prohibits a carrier from terminating a provider contract because the dentist refuses to allow third-party access. 

According to the ADA, the law also increases transparency by requiring payment explanations to identify the source of any network discounts.¹ 

Colorado Dental Association President Jeff Lodl, D.D.S. told the ADA that the legislation gives dentists greater control over their contractual relationships and whether or not they will be part of a leased network. 

Limits on claim adjustments and recoupment 

Financial impact of a claim does not end when an insurer processes the payment. Changes to the amount or attempts to recover a payment can cause uncertainty for dental practices. Indiana House Bill 1271 addresses concerns of payment of health claims. This includes downcoding, recoupment, and other payment-related practices.3 The law took effect July 1, 2026.⁴

The law establishes requirements for insurers when making certain downcoding decisions. If reimbursement is reduced based on medical necessity, insurers would not be allowed to rely on automated systems or tools to submit health benefits claims, the decision must receive a human review. 

The law also changes what happens after a claim has been paid. It limits an insurer’s recoupment of paid claims from two years to 180 days from the date the claim was paid, with no exceptions, including fraud.³ 

Shane Springer, director of government affairs for the Indiana Dental Association told the ADA that this legislation is addressing any burden and financial uncertainty with downcoding, which will help ensure dentists can focus on patient care.¹ 

Springer said that the law requires downcoding can be clinically justified and transparent.¹ 

Payment methods can affect reimbursement 

Even once the claim is paid, the payment method can affect how much reimbursement the practice receives. Electronic payment methods often carry transaction fees, something that practices must consider when processing insurance payments.  

Georgia’s 2026 legislation addresses how insurance payments are delivered to health care providers. House Bill 1374 focuses on how payment works for transactions and addresses electronic payment methods, including virtual credit cards and other methods that can carry transaction fees. The bill was enacted as Act 406 and took effect July 1.⁵ 

The law directly affects all health care insurance plans, their contracted vendors, and care-management organizations when initiating or changing payment methods using electronic funds transfers. The law requires express consent or an opt-in before allowing use of a payment method that can add additional fees for the provider. 

Other states such as Louisiana have also changed requirements surrounding virtual credit cards by replacing an opt-out system with an opt-in requirement.¹ 

Georgia Dental Association Senior Health Policy Manager Jon Hoin told the ADA that House Bill 1374 was modeled after the National Council of Insurance Legislators Transparency in Dental Benefits Contracting Model Act that was supported by the ADA. 

According to Hoin, the law is set to allow dentists, and all other health care providers, a choice over how they receive payment from insurers. He also said that payment methods that require fees can reduce funding available to practices for staffing, quality improvement, and other expenses.¹ 

Shorter windows for claim recovery 

Timing can affect both sides of the insurance cycle, with practices waiting on insurers to process a claim while insurers might be looking to recover past payments. Several states have addressed these timelines. Indiana limited the period of insurers being able to seek repayment of previously paid claims. Connecticut reduced its overpayment recovery period from 18 months to 12 months, and Oregon enacted House Bill 4040 establishing an 18-month limit.¹ 

Oregon House Bill 4040 also includes other effects on dental insurance claims, the law requires dental insurers to follow specific rules for payment and claims. A dental insurer can pay or deny clean claims within 45 days after receiving the claim. If any additional information is required, the insurer must notify the beneficiary and provider with an explanation of what information is needed.⁶ 

These provisions address two phases in a claim cycle and give strict timelines on both ends of the cycle. That distinction could matter for practices managing insurance accounts receivable as both timelines can affect insurance revenue. 

Changes to where payments go 

The next step within the payment process is determining where the insurer sends the money. Oregon and Maryland have enacted assignment-of-benefits legislation in 2026. According to the ADA, the new laws require insurers to pay dentists directly when patients request assignment of benefits, regardless of whether the dentist participates in the insurer’s network.¹ 

Oregon’s law requires insurers to pay the dental provider directly,⁶ while Maryland’s law goes a bit further and establishes patient notification requirements when payments are made directly to patients when assignment of benefits is not selected.¹ 

Tracking where premium dollars go 

While other reforms are more focused on transactions between practices and insurers, Mississippi is taking a broader approach by establishing requirements for dental loss ratio and reporting how dental insurance premium dollars are being spent.  

Mississippi enacted House Bill 1117, the Creating Transparency and Accountability in Dental Services Act, on March 17, which requires dental insurance carriers to calculate dental loss ratios and submit annual reports to the state’s insurance commissioner.⁷ 

The commissioner is required to make the reports available to the public through the Department of Insurance website and report collected data to the Senate and House insurance committees.  

The reports must include information such as enrollment, plan cost-sharing, deductibles, and annual maximums. The law also states how dental loss ratios are calculated, including patient care spending and premium revenue.⁷ 

The stated purpose of the law is to provide transparency and accountability around dental health care service premiums and to require annual reporting. This law does not directly affect how individual dental claims are reimbursed, it creates a record of how dental insurance premium dollars are allocated. 

Mississippi was among ten states that considered adding dental loss ratio legislation in 2026, according to the ADA. The ADA also reported that Mississippi Dental Association worked closely with legislators to address any technical questions about dental loss ratio calculations.¹ 

The limits of state-level reforms

State-by-state legislation can lead to some technical issues, according to the ADA many of those protections do not apply to patients covered by self-funded employer plans due to how insurers interpret the Employee Retirement Security Act (ERISA).¹ 

Insurers that are administering large self-funded employer plans have asserted that ERISA preempts state insurance laws, limiting the reach of some newly enacted requirements. 

Currently, the ADA is advocating for the Improving Dental Administration Act, which would clarify that state dental insurance laws apply more broadly to self-funded dental plans.¹ 

For now, the 2026 reforms remain largely state-specific, meaning practices will need to consider both the laws in their state and the type of dental benefit plan involved. 

References: 

1. American Dental Association. State dental insurance reforms continue momentum in 2026 legislative sessions. ADA News. Published July 2026. https://adanews.ada.org/ada-news/2026/july/state-dental-insurance-reforms-continue-momentum-in-2026-legislative-sessions 

2. Colorado General Assembly. HB26-1070: Dental insurance network leasing. 2026. https://leg.colorado.gov/bills/HB26-1070 

3. Indiana General Assembly. House Bill 1271. 2026. https://iga.in.gov/legislative/2026/bills/house/1271/details 

4. APTA Indiana. HB1271 announcement. March 25, 2026. https://inapta.org/2026/03/25/hb1271-announcement/ 

5. Georgia General Assembly. HB 1374: Insurance; methods of payment to healthcare providers; provide certain requirements. 2026. https://legiscan.com/GA/bill/HB1374/2025 

6. Oregon Legislative Assembly. House Bill 4040 2026 Regular Session. 2026. https://olis.oregonlegislature.gov/liz/2026R1/Downloads/MeasureDocument/HB4040/A-Engrossed 

7. Mississippi Legislature. Senate-referred version of House Bill 1117. 2026 Regular Session. 2026. https://billstatus.ls.state.ms.us/documents/2026/html/HB/1100-1199/HB1117SG.htm