Texas House Bills 198 and 4144 — both signed into law in 2025 — shift the responsibility for first-responder health onto public sector employers, instead of leaving employees to deal with the costs of occupational health risks on their own. Together, these two laws create one of the most comprehensive lifecycle health-and-benefit frameworks for first responders in the United States, spanning active service, early detection, and post-retirement protection.
While these new bills create an initial administrative lift and financial responsibility, they also present a strategic opportunity for municipalities in Texas. Leveraging both the policies and the data they generate can position Texas as a national model for public safety workforce innovation, occupational cancer research, and public sector talent attraction. Here’s what municipalities need to know.
Overview
HB 198 — also referred to as the Wade Cannon Act — and HB 4144 both relate to occupational health screenings and coverage, intervening at different points on a first responder’s career timeline.
The Wade Cannon Act[OC1] , named for a Texas first responder who died from occupational cancer at age 33[OC2] , requires employers of firefighters in Texas to offer occupational cancer screenings at no cost, starting during the fifth year of employment. After that, screenings must be offered annually. The law has been effective since June 1, 2026.
Screenings must be confidential and must test for each type of cancer, including:
Colorectal
Lung
Brain
Prostate, if applicable
While the Wade Cannon Act dictates requirements for preventive screenings during a first responder’s active career, HB 4144 [OC3] concerns itself with a municipality’s responsibility after an employee has retired. Effective since Sept. 1, 2026[SL4] , it requires employers [SL5] with 50 or more firefighters or peace officers to provide a supplemental income benefit for those who are diagnosed within three years of retirement. Covered illnesses include:
Cancer that originates in the stomach, colon, rectum, skin, prostate, testis, or brain
Non-Hodgkin's lymphoma
Multiple myeloma
Malignant melanoma
Renal cell carcinoma
Acute myocardial infarction
Stroke
The benefit must be the lesser of the retiree’s final annual salary or $100,000. Employers may pay the benefit in a lump sum or in equal payments over three consecutive months.
Importantly, these provisions don’t apply to municipalities that offered a health benefit plan that was comparable in cost and coverage on the day before the employee's retirement date.
Some aspects of each law still lack clarity in key areas
With each law still in its infancy, there are some points of confusion related to compliance. The Texas Commission on Fire Protection (TCFP) — which will serve as the rulemaking authority for HB 198 — has proposed a new section implementing the requirements of the bill that outlines minimum screening standards aligned with the National Fire Protection Association (NFPA). However, the section is out for review, and it’s still unknown when it will be fully approved.
[SL6] In the meantime, coordinating a process that ensures every eligible employee can access free screenings can be fragmented and tricky, not including the administrative lift of determining and notifying who immediately qualifies for the free screenings. One area of uncertainty is whether standard health screenings conducted during annual wellness exams will fulfill the requirements of the law. As it stands, there may be some overlap; however, occupational health screenings are different from standard health screenings, and it’s ultimately up to the TCFP to approve.
Similarly, the current iteration of HB 4144 doesn’t specify how many times the supplemental income benefit must be paid. This means there is a possibility that employers could be responsible for providing the benefit multiple times to the same retiree, if that retiree is diagnosed with more than one of the covered conditions. With this interpretation, an employer could be required to pay out much more than the single $100,000 benefit for just one employee.
Early solutions amid confusion
Going forward, the most seamless way to comply with the Wade Cannon Act will likely involve hosting annual occupational health exams and cancer screenings for employees. Those plans must be submitted for approval to the TCFP before Feb. 1 each year to ensure they comply with the law.
When selecting reputable and compliant providers for occupational cancer screenings, there are a few things to consider:
Physician-led occupational medical programs
Alignment with NFPA standards and TCFP rules
Scalable, mobile delivery options
Audit-ready compliance records
Longitudinal health tracking and reporting
Follow-up care and medical referrals with personal physicians
Be wary of any providers who are offering cost-share models that require employees to pay, don’t have physician oversight, or only offer cancer screenings without full medical testing.
For HB 4144, The Texas Municipal League (TML), MetLife, and Amwins have partnered to create a solution that meets the requirements of the law, and it is currently the only solution that is approved by the Texas Department of Insurance (TDI). Non-members of the TML risk pool can join for free to obtain access to the coverage.
The TML IRP/MetLife policy is unique in that it has no pre-existing condition exclusions or restrictions to the definition of cancer, which are not specified in the law. Perhaps more importantly, the TML IRP/MetLife policy addresses the ambiguity of the law with the most conservative interpretation: It will pay out once for each of the seven possible conditions, while the next best option pays out for only three.
The strategic opportunity
While other states recognize occupational risks through policy, few have laws that compare to Texas HBs 4144 and 198. States like New York, Florida, and California normally require a diagnosis during employment for any post-retirement benefit payouts, for example, and typically those benefits are built into pension or disability systems.
Comparable policies to the Wade Cannon Act are more fragmented in other states. The frequency of screenings varies widely, and they are not typically mandated statewide. In addition, many of the costs depend on funding programs, unions, or local policies rather than being required by law.
These gaps create a real strategic opportunity for Texas to become a national leader in cancer research data and talent acquisition for first responders. Texas municipalities should strategically market the benefits that the laws mandate: free cancer screenings throughout the career, up to $100,000 in post-retirement illness protection, and coverage that’s tied to occupational risk, as opposed to generic benefits.
In addition, data collected as a result of these laws may become crucial in predictive analytics for things like early cancer detection trends, or exposure risk mapping relative to incidents or geography. As more data is collected, it may also be effective in forecasting costs for retiree benefits under HB 4144.
To take advantage of this strategic opportunity, public sector entities should think about ways to standardize data collection. Data may include de-identified screening results, participation rates, and cancer incidence by tenure or exposure. In the interest of easing administrative burden[SL7] , entities should consider trying to pool data across cities and counties in Texas, exploring the possibility of partnerships with large research institutions such as the University of Texas, Texas A&M, or Texas Tech University Health Sciences.
By signing these bills into law, Texas has emphasized early detection over reactive care, and enduring illness protection that is effective both before and after the date of retirement. If implemented strategically, this legislation could make Texas a national leader in first responder occupational health research, attracting federal grants and even private health innovation to the state.
For more information, contact your Lockton representative or visit our webpage (opens a new window).