On October 1, 2026, the Nyeli Rose Lewis Act took effect in Maryland, requiring nursing homes, assisted living programs, nurse midwives, and licensed certified midwives to tell each resident and prospective resident, in writing or by written electronic communication, when they do not maintain professional liability insurance or when that coverage has lapsed and has not been renewed. The law also requires conspicuous posting of the fact that coverage has not been maintained. Governor Wes Moore signed the measure on April 14, 2026 as Chapter 32 (Senate Bill 293) and Chapter 33 (House Bill 442), after the Senate passed it 43-0 and the House passed it 134-0 on the Senate side, with matching unanimous votes on the House version (Maryland General Assembly, SB 293).
Most coverage of the bill has treated it as a consumer-protection story: families deserve to know whether the facility caring for a parent can actually pay for a mistake. That reading is correct, but it misses who the law actually reaches. A disclosure mandate only binds entities that might plausibly go bare, and in long-term care that population is dominated by two groups: small standalone operators that cannot buy coverage at any price they will pay, and larger self-insured structures, including hospital systems and county-owned facilities, that deliberately retain the risk. If your organization funds senior care professional liability through a captive, a trust, or a straight balance-sheet accrual, Maryland has just converted an internal risk-financing decision into a public fact.
What the law actually requires
The act amends Sections 19-1401, 19-1417, 19-1801, and 19-1808.1 of the Health-General Article and Sections 8-604 and 8-6D-15 of the Health Occupations Article. The mechanics are simple: written or electronic notice to each current resident and each prospective resident when professional liability coverage is absent or has lapsed without renewal, plus conspicuous posting of the same information at the facility. The Maryland Office of the Long-Term Care Ombudsman, which advocates for the more than 54,000 Marylanders living in nursing homes and assisted living facilities and investigated 3,978 verified complaints in fiscal 2025, testified in favor of the House version, framing the bill as a transparency and informed-consent measure (Ombudsman testimony, February 10, 2026).
Notably, the law does not require anyone to buy insurance. It requires disclosure. That distinction is what creates the reserve consequence.
Who it affects
Three groups should read this as an actuarial event rather than a compliance item:
- Self-insured senior care operators with Maryland locations, including multi-state chains that retain professional liability above a large self-insured retention or fund it entirely through a captive.
- Hospital systems and public entities that own or operate skilled nursing facilities, assisted living programs, or affiliated midwifery practices. County nursing homes and hospital-system long-term care wings are squarely covered, and many of them self-insure by design. If you carry long-term care exposure through the same program as your hospital professional liability, the disclosure obligation lands on the same balance sheet; our hospital professional liability IBNR guide covers how those programs are typically structured.
- Midwifery practices, where the exposure is birth-related and the tail is long. A licensed certified midwife going bare in Maryland now has to say so, in writing, to every client.
The reserve mechanism: disclosure as a frequency driver
The actuarial question is not whether the law changes the underlying care. It changes the information environment around claims, and the information environment feeds frequency.
Here is the mechanism. Nursing home litigation has increasingly featured arguments aimed at the defendant’s finances rather than the specific care delivered: who owns the facility, what the staffing budget was, whether the operator is underfunded. A posted notice stating that a facility carries no professional liability coverage hands a plaintiff’s firm two things at once. First, a jury argument that the operator has already concluded its care is not worth insuring. Second, confirmation that any recovery comes from the operator’s own assets, which reframes settlement posture for a self-insured entity with visible balance-sheet depth. A county or hospital system with bond ratings and audited financials is, in that framing, an attractive target precisely because it can pay.
For reserving, that is a frequency and expected-claim-ratio shift at the flagged locations, not a severity shift. The severity distribution for a pressure-ulcer or elopement claim does not change because a sign went up in the lobby. What changes is the probability that an incident becomes a claim, and that a claim becomes a suit rather than a negotiated settlement. If your actuarial report uses a single expected claim ratio for senior care locations across a multi-state book, the Maryland locations now carry a different frequency profile than the rest, and a blended pick will understate them.
There is a second-order effect on case reserves. For open Maryland claims, coverage status is now a matter of public record, which means defense counsel will assume the plaintiff’s counsel knows it. That can shift negotiation dynamics on claims already in the pipeline, and it argues for a fresh adequacy review of case reserves on open Maryland senior care files rather than waiting for the next annual study. Our case reserve strengthening guide walks through when a targeted review, rather than a full re-reserve, is the right response.
Where this shows up in your reserves
Open your most recent actuarial report and look for three things. First, the expected claim ratio or loss rate assumptions by state: if Maryland senior care locations are not broken out, ask why. Second, the frequency assumptions underlying the IBNR calculation for the affected locations; a disclosure-driven frequency lift flows straight into pure IBNR on recent accident periods, which is exactly the slice a pure versus broad IBNR analysis should isolate. Third, if you fund through a captive, the Schedule P or equivalent exhibit rows for other liability occurrence coverage: a frequency shift at a handful of locations is small against the whole program, but it concentrates in the Maryland rows and will surface there first in development. Public entities should also note that Maryland has been an active jurisdiction for expanding liability exposure to institutions generally; the state’s earlier revival-window legislation affecting public-entity abuse reserves, covered in our analysis of Maryland CVA claims, shows how quickly a disclosure and litigation environment can move. Our public entity GL IBNR guide covers the baseline structure for these programs.
What this means for your next review
Put Maryland on the agenda for your next interim monitoring meeting, ahead of the annual study. The specific question for your actuary is whether the expected claim ratio and frequency picks for Maryland senior care locations reflect post-disclosure claim behavior, and if not, what it would take to reflect it. The law took effect October 1, so the first claims filed against disclosed-uninsured facilities will not emerge for quarters; the right move now is a documented assumption decision, not a number change.
Decision-maker checklist
- Confirm whether any Maryland location in your program would be required to disclose, including affiliated midwifery practices and assisted living programs, not just skilled nursing.
- Ask your actuary whether Maryland senior care locations are picked separately in the expected claim ratio, and if not, request a split at the next study.
- Direct a case reserve adequacy review of open Maryland senior care claims, since coverage status is now public and negotiation dynamics may have shifted.
- If you fund through a captive, ask whether the disclosure affects how the captive’s fronting carrier or auditor views the Maryland exposure.
- Track the 2027 legislative sessions in neighboring states; disclosure mandates that pass one state with unanimous votes tend to travel.
What to watch
The directional call: Maryland is a plausible leading indicator rather than an isolated event. A disclosure mandate passed both chambers without a single dissenting vote, at essentially zero fiscal cost to the state, and with ombudsman support on the record. That is a low-cost, high-visibility template that patient-advocacy groups in other states can copy in 2027. If a second or third state adopts a comparable professional liability disclosure requirement for long-term care next session, multi-state operators should expect their actuaries to revisit frequency assumptions for the affected states as a group, and self-insureds with concentrated senior care books should treat the pattern, not the individual statutes, as the reserving event.
An independent reserve review brings a second pair of eyes that’s free of the TPA’s or fronting carrier’s incentive structure. We’re working on a directory of independent reviewing actuaries. If you’d like to be considered, get in touch.
Sources
- Maryland General Assembly, SB 293 (Chapter 32, Laws of 2026), bill details and history
- Maryland General Assembly, HB 442 (Chapter 33, Laws of 2026), bill details and history
- Chapter 32 (SB 293), enacted bill text, Nyeli Rose Lewis Act of 2026
- Maryland Office of the Long-Term Care Ombudsman, testimony in support of HB 442, February 10, 2026
- Maryland Department of Legislative Services, Fiscal and Policy Note (Revised), SB 293