Starting January 1, 2027, a new California law requires large-group health plans to cover scalp cooling — the chilled-cap treatment that can reduce hair loss during chemotherapy. The law is Assembly Bill 1682 (Chapter 541, Statutes of 2026). Governor Newsom signed it on September 27, 2026.
Most IHSS recipients are not on a large employer plan. They have Medi-Cal. The law adds scalp cooling to Medi-Cal too, but only after the federal government approves it, and no Medi-Cal start date has been announced. Here is what the law actually says, who it reaches, and what to ask before your first infusion.
AB 1682 at a glance
California's scalp cooling law — Chapter 541, Statutes of 2026
- StartsPlans issued, amended, or renewed on or after January 1, 2027. Not required before then.
- Who must cover itLarge-group plans from a job (regulated by DMHC or the Department of Insurance)
- Medi-CalAdded as a benefit, but only after federal approval. No start date announced yet.
- What countsFDA-cleared scalp cooling systems only. Manual cold caps are excluded.
- Your costCopays and deductibles allowed, but no worse than for other oncology supportive care in your plan
- Not covered by this lawIndividual plans, Covered California, small-employer plans, self-funded employer plans, Medicare
What scalp cooling is
A scalp-cooling system pumps chilled liquid through a snug silicone cap worn before, during, and after each chemotherapy infusion. The cold narrows blood vessels in the scalp, so less of the drug reaches the hair follicles. That is the description in the California Health Benefits Review Program (CHBRP) analysis the Legislature requested.
The law only counts devices cleared by the U.S. Food and Drug Administration (FDA). CHBRP identified three: Paxman, DigniCap, and Amma. The law says in plain terms that it does not cover cold caps that are not FDA-cleared, whatever they are called. That rules out manual caps kept in a freezer or on dry ice.
It takes time
According to CHBRP, cooling starts about 30 minutes before the infusion, runs through it, and continues for roughly 90 minutes to 3 hours after. A 2-to-3-hour infusion visit can stretch to 4 to 6 hours. A typical course is 4 to 8 sessions, and skipping cooling at one session removes the protection for that cycle.
What a chemo day with scalp cooling looks like
- Before · about 30 minCap is fitted and the scalp is pre-cooled
- During · your infusionCooling continues for the whole chemotherapy infusion
- After · 90 min to 3 hrsCooling continues after the infusion ends
Total: a 2–3 hour visit can become 4–6 hours. A typical course is 4–8 sessions, and skipping cooling at one session removes protection for that cycle. Source: CHBRP Technical Brief.
Does it work?
CHBRP found strong evidence that Paxman and DigniCap reduce chemotherapy-related hair loss compared with no cooling. In the research, “working” meant losing half of your hair or less — not keeping all of it. It does not work for everyone. The most common complaints were chills (42% of users), a heavy cap (35%), and headache (30%), and about 18% of people stopped. CHBRP found no increase in the risk of cancer spreading to the scalp.
The law covers scalp cooling when a health care provider prescribes it for chemotherapy that uses drugs known to cause hair loss. It does not list specific cancers. Whether you are a good candidate is a decision for you and your oncologist.
Evidence on hair type is limited and mixed.
CHBRP reported some evidence that scalp cooling may work less well for Black patients with tightly coiled hair, partly because of how the cap fits. The law does not address that. Ask your care team how they fit caps for your hair type.
Who the new law covers
The bill started out applying to almost all state-regulated health coverage. It was narrowed in August 2026 to large-group plans and Medi-Cal, and that is the version that became law (KQED).
Does AB 1682 require my coverage to pay for scalp cooling?
| Type of coverage | Required? | Details |
|---|---|---|
| Large-group plan from a job | Yes | For plans issued, amended, or renewed on or after Jan. 1, 2027. Covers DMHC-regulated plans and CDI-regulated insurance. |
| Medi-Cal (including managed care plans) | Waiting | Added as a benefit only after federal approval. Subject to medical necessity and prior approval. No start date yet. |
| Individual plans, including Covered California | No | Not required by this law. |
| Small-employer plans | No | Not required by this law. |
| Self-funded employer plans | Generally no | Governed mainly by federal law, not state coverage mandates. |
| Medicare and Medicare Advantage | Not changed | Federal program. Ask your infusion center how it bills Medicare. |
Source: AB 1682 chaptered text (Health & Safety Code §1367.651, Insurance Code §10123.811, Welfare & Institutions Code §14132.65). "Large group" generally means an employer with more than 100 employees.
- Large-group plans from a job: Covered for plans issued, amended, or renewed on or after January 1, 2027. This applies to HMO-type plans regulated by the Department of Managed Health Care (DMHC) and insurance policies regulated by the Department of Insurance (CDI). In California, “large group” generally means coverage through an employer with more than 100 employees — your plan can confirm which you have.
- Individual plans (including Covered California) and small-employer plans: Not required by this law.
- Self-funded employer plans: Generally not. These plans are governed mainly by federal law, not state coverage mandates (CURE).
- Medi-Cal, including Medi-Cal managed care plans: Added as a Medi-Cal benefit, but only once federal approval and federal funding are in place. More on this below.
- Medicare and Medicare Advantage: Not changed by this law. Medicare is a federal program.
Check your plan's renewal date.
The requirement applies to plans "issued, amended, or renewed on and after January 1, 2027." If your employer plan renews on July 1, the requirement may not reach you until July 2027. Ask your plan or your HR office when your plan year starts. If your job offers more than one plan during open enrollment this fall, ask HR which options are fully insured — self-funded options are not covered by this law.
Medicare in California is not settled.
CHBRP's analysis says automated scalp cooling is covered and paid for under Medicare, and new billing codes took effect in 2026. The one formal Medicare coverage policy we found comes from Palmetto GBA, a contractor for seven southeastern states — not California. We could not confirm a written policy from California's Medicare contractor. If you have Medicare, ask your infusion center whether it bills Medicare for scalp cooling before you start.
If your chemotherapy starts before January
The law does not require any plan to cover scalp cooling before its 2027 plan year begins. If your chemotherapy starts in November or December, your course may run past your plan’s renewal date. The law does not say how treatment already in progress is handled. Ask your plan, in writing, whether sessions after the renewal date will be covered and whether you will need a new prior authorization.
What you might pay
The law does not make scalp cooling free. Large-group plans may charge copays, coinsurance, or deductibles, but those costs can be no less favorable than what the same plan charges for “oncology supportive care services.”
Without coverage, the costs are real. A Sharp HealthCare oncologist told KPBS that scalp cooling can add $2,500 to $5,000 out of pocket. CHBRP estimated an average of about $3,700 a year per person who uses it. CHBRP also noted that Medi-Cal members generally have no cost sharing — which will matter once the Medi-Cal benefit begins.
Patients bring their own fitted silicone cap to each session, according to CHBRP. Ask the infusion center whether the cap is part of what gets billed to your plan or a separate cost.
"Oncology supportive care services" is not defined in the law.
Plans will decide what they compare scalp cooling to when they set your share of cost. How that works in practice has not been tested yet. If your cost share looks higher than for other chemo-related care, ask the plan in writing what it used as the comparison.
Medi-Cal: the part that matters most for IHSS households
IHSS depends on Medi-Cal — DHCS tells IHSS recipients they must renew Medi-Cal to keep IHSS. So for most of our readers, the Medi-Cal section of the law is the one that counts.
- It is a covered benefit — on paper. Welfare and Institutions Code section 14132.65 adds scalp cooling to Medi-Cal when it is prescribed for hair-loss-causing chemotherapy.
- It waits on federal approval. The section applies only once any needed federal approvals are obtained and federal funding is available.
- Expect prior authorization. Coverage is subject to “utilization controls and medical necessity.” In plain terms, your plan or Medi-Cal can require approval before treatment and can deny it if the request does not show medical need.
- Medi-Cal managed care plans follow the Medi-Cal rule, not the large-group rule. The law says so directly.
- DHCS can roll it out by letter. The law lets DHCS implement the benefit through all-plan letters, provider bulletins, or similar instructions without formal regulations.
- If you have both Medicare and Medi-Cal, Medicare pays first.
Some early news coverage described Medi-Cal coverage as starting January 1. The law itself does not set a Medi-Cal start date. It ties the benefit to federal approval.
No Medi-Cal start date yet.
As of this article's publication, DHCS had not announced when the scalp cooling benefit will begin. Until DHCS issues guidance, a Medi-Cal plan may not have instructions for approving it. If you are starting chemotherapy now, ask your oncologist's office to submit a request anyway and keep a copy of any denial — you may need it to appeal or to show the date you asked.
Before your first infusion: what to ask
Scalp cooling has to be set up before chemotherapy starts. The cap is fitted ahead of time, and protection depends on cooling at every session. Start these conversations early.
Five steps before your first infusion
- Ask your oncologistIs my chemotherapy likely to cause hair loss? Am I a good candidate for scalp cooling? Is there anything about my health that makes the cold a problem?
- Ask the infusion center if it has an FDA-cleared systemCHBRP found these systems are concentrated in the Bay Area, Los Angeles, and San Diego, with limited access in the Central Valley, Northern California, and rural areas.
- Call your planIs my plan large group? Fully insured or self-funded? When does it renew? Do you require prior authorization? What will I pay? Write down the date, the name, and a reference number.
- Get it prescribedThe law covers scalp cooling when a health care provider prescribes it. Ask the office to document the prescription and the chemotherapy drugs involved.
- Plan the dayExpect a chemo day to run 4 to 6 hours with cooling. Line up a ride home, food, and help for the rest of the day.
- Ask your oncologist. Is my chemotherapy likely to cause hair loss? Am I a good candidate for scalp cooling? Is there anything about my health that makes the cold a problem?
- Ask the infusion center if it has an FDA-cleared system. CHBRP found these systems are concentrated in the Bay Area, Los Angeles, and San Diego, with limited access in the Central Valley, Northern California, and rural areas.
- Call your plan. Is my plan large group? Is it fully insured or self-funded? When does it renew? Do you require prior authorization? What will I pay? Write down the date, the name of the person, and a reference number.
- Get it prescribed. The law covers scalp cooling when a health care provider prescribes it. Ask the office to document the prescription and the chemotherapy drugs involved.
- Plan the day. Expect a chemo day to run 4 to 6 hours with cooling. Line up a ride home, food, and help for the rest of the day.
If coverage is denied
Your denial letter or member handbook usually says which state agency oversees your plan. Start with the plan’s own appeal or grievance process, then go to the regulator.
- Employer HMO-type plans (DMHC): DMHC Help Center, 1-888-466-2219.
- Employer insurance policies (CDI): Department of Insurance Consumer Hotline, 1-800-927-4357 (TTY 1-800-482-4833).
- Medi-Cal managed care: Appeal to your plan within 60 days of the denial notice. After that, you can ask for a state hearing: 1-800-743-8525 (TDD 1-800-952-8349). The Medi-Cal Managed Care Ombudsman is at 1-888-452-8609.
- Free help with any of these: Health Consumer Alliance, 1-888-804-3536 (TTY 1-877-735-2929).
Denied? Who to call
Start with your plan's appeal or grievance process. Your denial letter or member handbook usually names the state agency that oversees your plan.
- Employer HMO-type plan (DMHC)DMHC Help Center1-888-466-2219
- Employer insurance policy (CDI)Dept. of Insurance Consumer Hotline · TTY 1-800-482-48331-800-927-4357
- Medi-Cal: state hearingAppeal to your plan first, within 60 days of the denial · TDD 1-800-952-83491-800-743-8525
- Medi-Cal Managed Care OmbudsmanHelp with Medi-Cal plan problems1-888-452-8609
- Free help with any coverage problemHealth Consumer Alliance · TTY 1-877-735-29291-888-804-3536
If you get IHSS or are an IHSS provider
Chemotherapy days are long, and scalp cooling makes them longer. Two existing benefits can help.
- Accompaniment to medical appointments is an authorized IHSS task under Welfare and Institutions Code section 12300 and MPP 30-757.15. If treatment adds appointments or changes what you need help with at home, ask your county social worker for a reassessment.
- Medi-Cal rides. Medi-Cal covers transportation to medical appointments: non-medical transportation (NMT) for people with no other way to get there, and non-emergency medical transportation (NEMT) when a provider prescribes it. See DHCS Transportation Services. Tell the plan your appointment may run 4 to 6 hours so the return trip is scheduled correctly.
Tell your county when treatment starts.
A cancer diagnosis and chemotherapy can change your needs quickly. Counties reassess IHSS hours when a recipient's needs change. Call your social worker, describe what has changed, and ask for a reassessment rather than waiting for your annual visit.
Waiting time during long infusions.
We did not find a statewide rule on how much of a 4-to-6-hour infusion an IHSS provider can count as accompaniment time. Ask your social worker how your county handles it, and keep a simple log of actual arrival, start, and end times.
What the law does not do
- It does not cover manual cold caps or any product that is not FDA-cleared.
- It does not apply to individual plans, Covered California, small-employer plans, or self-funded employer plans.
- It does not put a scalp-cooling machine in every infusion center.
- It does not guarantee results. Scalp cooling reduces hair loss for many people, not all.
- It does not, by itself, start Medi-Cal coverage. That waits on federal approval and DHCS guidance.
Sources
- AB 1682 (Hart), Chapter 541, Statutes of 2026 — chaptered bill textLarge-group requirement and January 1, 2027 date; cost-sharing parity with "oncology supportive care services"; FDA-cleared definition and cold-cap exclusion; Medi-Cal benefit (W&I §14132.65), federal approval condition, utilization controls and medical necessity, DHCS implementation by letter; Medi-Cal managed care carve-out; signed September 27, 2026. Read directly.
- CHBRP, Analysis of California Assembly Bill 1682: Scalp Cooling (April 4, 2026)Device names; effectiveness and side-effect percentages; no increased scalp metastasis; hair-type evidence; average annual cost estimate; Medi-Cal no cost sharing; Medicare coverage statement; geographic concentration. Analyzes the broader introduced bill.
- CHBRP, AB 1682 Scalp Cooling Technical BriefHow scalp cooling works; pre- and post-cooling time; 4–6 hour visits; 4–8 sessions; patients bring their own cap.
- KPBS, "A new California law may help more cancer patients keep their hair" (Sept. 29, 2026)$2,500–$5,000 out-of-pocket estimate from a Sharp HealthCare oncologist.
- KQED, "California Could Join Handful of States That Cover Cancer Hair-Loss Treatment" (Sept. 18, 2026)Bill narrowed to large-group plans and Medi-Cal; earlier version applied more broadly.
- CURE, "California Will Require Coverage of Scalp Cooling During Chemotherapy" (Oct. 2026)Self-funded employer plans generally governed by federal law.
- Paxman, "Palmetto GBA Approves First Local Coverage Determination for Scalp Cooling Therapy" (manufacturer release)Palmetto GBA Medicare policy covers seven southeastern states. Manufacturer source.
- DHCS, IHSS and Medi-Cal flyerIHSS recipients must renew Medi-Cal to keep IHSS.
- DHCS, Transportation ServicesMedi-Cal NMT and NEMT rides to medical appointments.
- DHCS, Medi-Cal Managed Care Office of the OmbudsmanOmbudsman phone number.
- California Department of Managed Health Care (ca.gov listing)DMHC Help Center phone number.
- California Department of Insurance, Health care complaint processCDI Consumer Hotline and TTY.
- California Welfare and Institutions Code §12300Accompaniment to medical appointments as an IHSS service.
The chaptered text of AB 1682 is the primary authority throughout. CHBRP figures describe the bill as introduced in February 2026, before it was narrowed to large-group plans and Medi-Cal; we use them for clinical facts, not for who is covered.
About this article
IHSS Connect publishes this article for general information and education. It is not legal or medical advice, and reading it does not create an attorney–client relationship. IHSS Connect is not a law firm and is not affiliated with the California Department of Social Services, the Department of Health Care Services, the Department of Managed Health Care, the Department of Insurance, or any county agency.
Benefit rules, dollar amounts, and start dates change — sometimes mid-year. Only your health plan, Medi-Cal, and your doctor can decide what is covered and appropriate for you, and only your county can decide your IHSS hours.
If a decision on your coverage looks wrong, or you want advice about your own situation, talk to someone who can look at your file:
- Free and low-cost legal help: LawHelpCA.org
- Health Consumer Alliance (free help with health coverage problems): 1-888-804-3536
- CDSS Public Inquiry and Response: 1-800-952-5253
Law text and contacts verified October 2026.
