State Policy · NJ
New Jersey Parents Push Insurance Mandate for PANS and PANDAS Treatment Coverage
New Jersey lawmakers are considering legislation requiring commercial insurers to cover treatment for PANS and PANDAS, rare pediatric neuropsychiatric disorders often triggered by infections. The bill, introduced in fall 2025, has bipartisan support but has not yet received a hearing. Seventeen states have already adopted similar mandates. A state advisory commission found treatments cost $10,000-$15,000 annually per patient but noted limited clinical evidence for the most expensive therapies. The proposed mandate would not apply to Medicaid, which covers over one-third of New Jersey children, though NJ Family Care currently covers medically necessary treatment.
Why it mattersIf enacted, this mandate would expand commercially-insured benefit requirements but explicitly exclude Medicaid — raising potential access disparities for the one-third of New Jersey children enrolled in NJ Family Care, even though the state program already covers medically necessary treatment under existing policy.