WV SB1019

Mandates insurance coverage for medically necessary treatment of cleft lip and cleft palate for children from birth through age 18 across all major insurance types in West Virginia, including Medicaid, public employee plans, and private insurers.

Required covered treatments include oral and facial surgery, prosthetic devices (obturators, speech appliances, feeding appliances), orthodontic care, prosthodontic care, and otolaryngology (ear, nose, throat) treatment.

Excludes purely cosmetic surgery performed to reshape normal structures of the lip, jaw, palate, or other facial features solely to improve appearance.

Insurers may apply the same deductibles, coinsurance, and cost-sharing requirements to cleft lip/palate treatment as they impose on other surgical benefits.

Effective date is July 1, 2026, applying to all policies delivered, issued, amended, or renewed on or after that date.