More states expanded nurse practitioner practice authority in the past 12 months than in any comparable period in the profession’s history. Between the second half of 2025 and the first half of 2026, NPs gained new ground in states that had resisted change for years, including New Jersey and Oklahoma, while facing urgent deadlines in others.
The count as of mid-2026: approximately 30 states and Washington, D.C., now grant some form of full practice authority to nurse practitioners, up from 22 in 2020. The pace of change has been driven by the same pressures that have been building for a decade: physician shortages projected to reach 124,000 by 2034, mounting evidence that NP-led care produces comparable outcomes at lower cost, and the lasting lessons of pandemic-era waivers that proved NPs could practice safely without physician oversight.
This roundup covers the states where meaningful legislative action occurred in 2025 and early 2026, what each change means for NPs practicing there, and how expanded practice authority affects your insurance. If your state isn’t listed here, the AANP’s interactive State Practice Environment map is the most current source for your specific practice authority status.
New Jersey: Full Practice Authority for Primary Care and Behavioral Health NPs
On March 30, 2026, Governor Mikie Sherrill signed Senate Bill 2996 into law, eliminating the joint protocol requirement for qualified Advanced Practice Nurses in New Jersey. The legislation came just days before an April 2 deadline that would have forced thousands of NPs back into collaborative agreements after pandemic-era waivers expired.
What changed: NPs in New Jersey with more than 5,000 hours of licensed clinical experience can now practice independently and prescribe medications without a joint protocol agreement with a physician. Hours worked under the previous waiver period count toward the 5,000-hour threshold, meaning many NPs qualified immediately.
What’s limited: The law applies specifically to primary care and behavioral health settings. NPs in other specialty areas are not covered by this expansion and continue to operate under existing collaborative requirements. Aesthetic and procedural NPs should confirm how their practice classification intersects with the new law.
What it means for your insurance: NPs in New Jersey who transition from collaborative practice to independent practice should review their coverage. Greater clinical autonomy means a different liability profile. CM&F policies automatically conform to your state’s scope of practice, so as your legal authority expands, your policy expands with it. But NPs in New Jersey who are now considering opening their own practices should also evaluate whether they need group liability coverage, general liability, and cyber coverage on top of their individual professional liability policy.
New York: The July 2026 Regulatory Cliff
New York’s situation is one every NP in the state should be watching closely. In 2022, the state eliminated the collaborative agreement requirement for NPs with 3,600+ hours of practice experience. That provision was extended through the state budget process and is currently scheduled to expire on July 1, 2026.
What’s at stake: If the New York State Legislature does not act before July 1, the state reverts to its earlier framework. NPs who have been practicing independently would be legally required to re-enter formal collaborative agreements with physicians, regardless of how many years of experience they have. The Nurse Practitioner Association of New York State has described this as a “regulatory cliff” that could disrupt care for hundreds of thousands of patients.
Where it stands: Senate Bill S2360, which would make NP independent practice permanent in New York, was referred to the Higher Education Committee in January 2026. The bill would remove the sunset clause entirely, allowing qualified NPs to practice without a collaborative agreement on a permanent basis. It would also expand collaboration options for newer NPs by allowing them to collaborate with experienced NPs (not just physicians). As of this writing, the bill has not yet been scheduled for a vote.
What it means for your insurance: New York NPs should be preparing for both outcomes. If S2360 passes, independent practice continues and the coverage considerations remain the same: ensure your policy reflects your full scope of practice. If the provision sunsets, NPs may need to re-enter collaborative agreements, and the administrative and legal complexity of that transition could create compliance exposure. Either way, confirm with your carrier that your coverage status is current. CM&F has detailed NP coverage information specific to New York.
Oklahoma: Prescriptive Authority After a Veto Override
In June 2025, the Oklahoma House and Senate voted to override Governor Kevin Stitt’s veto of House Bill 2298, granting qualified nurse practitioners independent prescriptive authority. The law took effect in November 2025.
What changed: NPs in Oklahoma who have completed 6,240 hours of clinical practice with supervised prescriptive authority can now prescribe medications, including Schedules III through V controlled substances, without a physician’s signature. This eliminates the costly collaborative agreements that NPs in Oklahoma had previously been required to maintain.
The backstory: Governor Stitt vetoed similar legislation in 2024, arguing that NPs should remain under physician supervision. The 2025 override reflected strong bipartisan support and years of advocacy by Oklahoma’s NP community, who argued that the supervision requirement was an administrative and financial burden that restricted access to care, particularly in rural areas.
What it means for your insurance: Oklahoma NPs who have transitioned to independent prescriptive authority are carrying a broader clinical scope than before. Prescribing independently means the prescribing decisions, and any resulting liability, rest entirely with you. Make sure your policy reflects your current prescriptive authority and covers the full range of medications you’re authorized to prescribe.
California: The AB890 Rollout Continues
California’s path to NP independence is different from any other state. Instead of a single legislative switch, the state is implementing a tiered transition under Assembly Bill 890, signed in 2020 and refined by SB 1451 in 2024.
How the tiers work: “103 NPs” can practice independently within defined healthcare settings (hospitals, clinics, community health centers). “104 NPs” can practice fully independently in any setting, but only after completing at least three additional years of 103-level experience. The first wave of 104-eligible NPs is on track for full independence in 2026.
What’s changed recently: SB 1451 (signed September 2024) streamlined the transition-to-practice requirements, expanded what counts as qualifying clinical experience, and simplified patient disclosure rules for NPs practicing independently. These refinements removed several administrative barriers that had slowed early implementation of AB890.
What it means for your insurance: California NPs moving through the tiered system should confirm their coverage reflects their current tier status and practice setting. A 103 NP practicing within a hospital has a different liability profile than a 104 NP opening an independent practice. If you’re approaching 104 eligibility and planning to go independent, evaluate your full insurance stack: individual professional liability, group coverage if you’re hiring, general liability for your practice location, and cyber coverage for patient data.
States to Watch in Late 2026 and Beyond
Several states have active legislation or are in early stages of expanding NP practice authority.
South Carolina introduced House Bill 3580 in January 2025, which would grant full practice authority to APRNs who meet specified criteria. The bill is still working through the legislative process.
Pennsylvania has been advancing NP practice authority legislation for several years. SB717 passed the state Senate, and the Pennsylvania Coalition of Nurse Practitioners continues to advocate for full practice authority at the state level.
Mississippi saw an FPA bill fail to pass in April 2025, but advocacy groups have indicated they will reintroduce legislation.
The APRN Compact is also advancing. Modeled after the existing Nurse Licensure Compact, the APRN Compact would allow advanced practice nurses to practice across state lines under a single multistate license. Several states have enacted the compact legislation, but it has not yet reached the threshold of states needed for full implementation. For NPs practicing via telehealth across state lines, the compact represents a potential shift in how multi-state practice is managed and insured.
What Expanded Practice Authority Means for Your Insurance
Every time a state expands NP practice authority, it changes the insurance landscape for NPs practicing there. Greater autonomy means a broader scope of clinical decision-making, which means a different risk profile. Here’s what to review when your state’s laws change.
Confirm your policy reflects your current scope. CM&F policies automatically conform to changes in your state’s scope of practice laws, so if your state expands your authority, your coverage expands with it. But it’s still worth confirming with your carrier, especially if you’re moving from a collaborative practice model to independent practice.
Review your coverage limits. NPs in full practice authority states earn an estimated 12-15% more than those in restricted states. Higher earning potential often comes with broader clinical exposure. Standard coverage starts at $1M/$3M per-claim and aggregate limits, with additional options available depending on your application inputs and practice profile. If you’re expanding into practice ownership or high-acuity specialties, your limits may warrant a conversation.
If you’re opening a practice, layer your coverage. Individual professional liability covers your clinical work. Group professional liability covers your business entity. Depending on your setup, you may also need general liability, cyber liability, and workers’ compensation. The CPOM laws in your state determine how your business entity should be structured.
Licensing board defense matters more in FPA environments. Independent practice means you may be the sole defendant in a complaint. Licensing board defense as a separate benefit ensures that defending your license never competes with defending a malpractice claim. Consent-to-settle rights ensure nobody settles a claim against you without your approval.
Key Takeaways
The NP full practice authority landscape has shifted significantly. New Jersey granted FPA for primary care and behavioral health NPs in March 2026. Oklahoma overrode a governor’s veto to grant prescriptive independence in 2025. California’s tiered AB890 system is reaching its next implementation phase. And New York faces a July 2026 deadline that could either make independent practice permanent or force thousands of NPs back into collaborative agreements.
Approximately 30 states and D.C. now grant some form of full practice authority to NPs, up from 22 in 2020. The movement is accelerating, driven by physician shortages, pandemic-era evidence, and growing bipartisan recognition that NPs deliver safe, cost-effective care.
Every expansion of practice authority changes your insurance picture. Confirm your policy reflects your current scope, review your coverage limits if you’re moving to independent practice, and make sure your policy includes licensing board defense and consent-to-settle rights.
This blog will be updated as additional states take action. For real-time updates, check the AANP State Practice Environment map.
Frequently Asked Questions
- Which states have nurse practitioner full practice authority in 2026?As of mid-2026, approximately 30 states and Washington, D.C., grant some form of full practice authority to nurse practitioners, up from 22 in 2020. Recent additions include New Jersey (primary care and behavioral health, signed March 2026) and Oklahoma (independent prescriptive authority, effective November 2025). California is implementing a tiered system under AB890, and New York faces a July 1, 2026, deadline to make its independent practice provisions permanent.
- Does full practice authority affect my malpractice insurance?Yes. Greater clinical autonomy means a broader scope of decision-making and a different liability profile. CM&F policies automatically conform to changes in your state’s scope of practice laws, so your coverage expands as your authority does. NPs transitioning to independent practice should also evaluate whether they need additional coverage layers like group liability, general liability, and cyber insurance, particularly if they are opening their own practices.
- What happens to NPs in New York if the full practice authority provision expires in July 2026?If the New York State Legislature does not extend or make permanent the current independent practice provisions before July 1, 2026, NPs who have been practicing without collaborative agreements will be required to re-enter formal physician collaboration arrangements. Senate Bill S2360, which would make independent practice permanent, has been introduced but not yet voted on. NPs in New York should monitor the legislation and confirm their coverage status with their carrier regardless of the outcome.
