California Will Require Coverage of Scalp Cooling During Chemotherapy

On Sept. 27, 2026, California Gov. Gavin Newsom signed Assembly Bill 1682, which requires certain health plans to cover scalp cooling for people receiving chemotherapy. Starting Jan. 1, 2027, large-group health plans and insurance policies issued, amended or renewed in California must cover scalp cooling when it is prescribed to reduce hair loss before, during or after chemotherapy that causes hair loss.

The law also adds scalp cooling to Medi-Cal, California's Medicaid program, once federal approval is in place. Medi-Cal coverage will depend on medical necessity.

What Scalp Cooling Is

Hair loss, also called alopecia, is a common side effect of many chemotherapy drugs. Scalp cooling uses a tightly fitted cap that is chilled before, during and after each infusion. Cooling the scalp narrows the blood vessels there, which lowers the amount of chemotherapy that reaches the hair follicles.

"Scalp cooling is a mechanism that uses a portable refrigeration unit and a very well-fitted cap for the patient," Dr. Mariela Macias, an oncologist at Sharp HealthCare in San Diego, told KPBS. She said that for many patients it reduces hair loss by up to 50% to 75%, but it does not work for everyone.

What the Law Requires

• Who is covered: People in large-group health plans and insurance policies regulated by California that are issued, amended or renewed on or after Jan. 1, 2027, plus Medi-Cal members once federal approval is granted.
• When it applies: When a clinician prescribes scalp cooling to reduce hair loss from chemotherapy that uses drugs known to cause hair loss.
• Which devices: The law covers FDA-cleared scalp cooling systems. The state's review of the bill identified three automated systems: Paxman, DigniCap and Amma. Manual cold caps kept in a freezer or on dry ice are not included, according to KPBS.

Why It Matters

Without coverage, scalp cooling can add $2,500 to $5,000 in out-of-pocket costs, Macias said. She said a few of her patients refused chemotherapy when scalp cooling was an out-of-pocket expense. Patients have pushed for wider access to scalp cooling, saying hair loss affects privacy, identity and how they cope with treatment.

What's Still Unknown

• The bill summary names large-group plans and Medi-Cal. It does not list small-group or individual plans. Employer plans that are self-funded are generally regulated under federal law rather than state insurance mandates.
• The bill summary does not say how much patients will pay in copays or deductibles for scalp cooling.
• The date Medi-Cal coverage begins depends on federal approval, which has not yet been announced.
• Scalp cooling does not prevent hair loss for everyone, and results vary with the chemotherapy regimen.

What It Means for You

If you live in California and will start chemotherapy in 2027 or later, check whether your plan is a large-group plan and when it renews, since the requirement applies to plans issued, amended or renewed on or after Jan. 1, 2027. Scalp cooling usually has to be set up before your first infusion, so raise it with your care team early.

Questions to Ask Your Care Team

• Is my chemotherapy likely to cause hair loss, and is scalp cooling an option with my regimen?
• Does this infusion center offer an FDA-cleared scalp cooling system?
• Will my health plan cover scalp cooling, and what will I pay?
• How long does each scalp cooling session add to my infusion time?

References

1. "AB 1682: Health Care Coverage: Scalp Cooling." California Legislature, Chapter 541, Statutes of 2026. Sept. 27, 2026.
2. "A New California Law May Help More Cancer Patients Keep Their Hair." KPBS. Sept. 29, 2026.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.