This election season brought about a number of newsworthy state law benefit changes, mostly in the way of constitutional amendments relating to reproductive health care. Below is a post-election overview of recent state law changes. This alert also includes an overview of other pressing state news and hot-button benefit issues from over this past quarter.
Executive Summary
Regarding abortion and reproductive health care:
Abortion measures appeared on ballots in ten states, with seven ultimately voting to enshrine protections in state constitutions. Georgia, North Dakota, and Ohio courts struck down state bans, though immediate challenges have already brought a stay to the Georgia decision and a request for a stay in North Dakota.
State litigation continues with several new and ongoing lawsuits in Texas, Wisconsin, and California, including a resurgence of a previously decided Mifepristone access challenge.
Delaware enacted a mandate requiring coverage of abortion and abortion-related services with no cost-sharing.
On gender-affirming care issues:
Oral arguments were scheduled for two major cases pending before the U.S. Supreme Court and the Eleventh Circuit Court of Appeals challenging the constitutionality of gender-affirming care prohibitions for minors.
Another Florida case has been stayed pending the outcome of the Eleventh Circuit Court of Appeals rehearing in its earlier Lange decision.
A Maine district court ruled that the U.S. Defense Department violated constitutional rights to equal protection by excluding gender-affirming surgery in its health plan.
Texas filed lawsuits against individual doctors, a health plan was sued for excluding gender-affirming care coverage and a series of states accused the American Academy of Pediatrics of violations in consumer protections over its guidance on gender-affirming care for minors.
Pharmacy matters were also active this past quarter:
The U.S. Supreme Court asked the U.S. Solicitor General to weigh in on a pharmacy benefit manager (PBM) case it is considering hearing.
An opinion from the Texas Attorney General clarifying the enforceability of two Texas bills against PBMs administering benefits under ERISA plans is still pending but is expected soon; meanwhile, the Texas Attorney General also filed a lawsuit against several PBMs over high insulin costs.
Several state bill updates surfaced amid hundreds of PBM bills still pending in state legislatures.
Additional updates to state laws and programs impacting employee health and welfare benefits this quarter included extensive new insurance mandates across California, Illinois and Massachusetts, and a failed ballot measure that would have made Washington’s long-term care insurance program optional.
Self-funded ERISA plans are generally not impacted by state insurance laws and, therefore, no immediate action is required from employers on the information discussed below. We nevertheless recommend that employers review current benefits in conjunction with state mandates to ensure that plan offerings keep pace with market changes and continue to meet enrollee needs and expectations.
ABORTION AND REPRODUCTIVE CARE
Voters Decide on Abortion Measures in 10 States
State constitutional amendments offering voters the opportunity to protect abortion rights appeared on 10 ballots this voting season, seven of which passed.
Notably, Arizona and Missouri passed measures establishing fundamental rights to abortion and preventing state restriction of abortion prior to fetal viability (generally 24-26 weeks) that conflict with both states’ existing abortion laws. Arizona currently permits abortion until 15 weeks and Missouri has a total ban in place (with limited exceptions to protect the health of the mother).
Ballot measures in Florida and South Dakota attempting to protect abortion access until fetal viability and in the first trimester, respectively, did not pass, leaving in place a six-week ban in Florida and a total ban in South Dakota.
Nebraska, which included two measures on its ballot, voted to pass a restrictive measure enshrining the state’s current 12-week ban in the state constitution, and failed to pass a protective measure that would have protected a right to abortion until fetal viability.
The remaining five states (Colorado, Maryland, Montana, Nevada, and New York) codified existing abortion rights by passing amendments designed to prevent any future laws from undoing current protections. New York’s measure went beyond just abortion, adding language to its existing Equal Rights Amendment to expand protections based on national origin, age, disability, sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes, or reproductive healthcare and autonomy.
Lockton comment: Approved ballot measures do not automatically reverse laws, so Arizona and Missouri restrictions remain in place until legal challenges are brought and resolved based on new amendments. On Nov. 6, 2024, Planned Parenthood filed a lawsuit in Missouri seeking to enjoin state bans and restrictions in order to restore access to abortion based on the new amendment. The ACLU of Arizona stated that it plans to take similar action in the coming weeks to both implement the new constitutional amendment and challenge other restrictions in place in Arizona, including waiting periods, limits on mail-order access to medications and ultrasound requirements. Opponents of the measure in Arizona have indicated that they are exploring legal options to challenge the amendment.
State Courts Overturn Abortion Bans
On Sept. 30, 2024, a Georgia superior court judge held that its “heartbeat law” banning abortion after six weeks was unconstitutional and cannot be enforced. The ruling permanently enjoined the ban, bringing the state’s previous abortion regulation back into effect that permits abortion until fetal viability (generally around 22 weeks). The state Attorney General quickly appealed, however, and the Georgia Supreme Court stayed the lower court’s decision while the appeal continues, thereby reinstating the six-week ban as of Oct. 7, 2024.
North Dakota’s near total prohibition was also struck down on Sept. 12, 2024 in a district court ruling stating that the law is unconstitutionally void for vagueness and that the state constitution gives women a “fundamental right to choose abortion.” As a result, abortion is now permitted until fetal viability. The state filed an appeal with the North Dakota Supreme Court in late October and requested a stay of the district court’s ruling while the case continues, but no ruling on the motion has been released to date.
Ohio followed suit, overturning a six-week abortion restriction that remains on the books despite a 2023 voter amendment enshrining a right to abortion until fetal viability. The state law has traveled a convoluted path since its inception: it was initially passed in 2019 but did not go into effect until June 2022 after the overturn of Roe v. Wade, then was temporarily blocked in September 2022 after a lawsuit challenged the constitutionality of the law. While litigation was pending, the state launched (and voters passed) a ballot initiative protecting abortion until fetal viability in the state constitution. The Ohio Supreme Court ruling, issued on Oct. 24, 2024, formally declared the six-week ban unconstitutional and unenforceable. The ruling also overturned other provisions of the law including waiting periods, notification requirements, and criminal and civil penalties. The attorney general’s office, which had acknowledged that the 2023 voter amendment made the six-week prohibition unconstitutional but wanted the court to uphold the other provisions, said it was reviewing the decision and would decide whether to appeal within 30 days.
Litigation Continues in Other States
U.S. Supreme Court Again Declines to Review State EMTALA Questions
The U.S. Supreme Court in early October declined to review an appeal brought by the U.S. Department of Health and Human Services (HHS) asking it to review a Texas court’s injunction of guidance it issued on the application of EMTALA to pregnant patients experiencing medical emergencies. In 2022, HHS notified hospitals nationwide that EMTALA required them to provide emergency care, including abortions if necessary, as a stabilizing treatment in a medical emergency, regardless of any state abortion ban or restriction. Texas filed suit challenging HHS’s directive, and a district court blocked the guidance in Texas temporarily in 2022 and again permanently in 2023. The Fifth Circuit Court of Appeals affirmed the district court’s decision in January 2024 and HHS petitioned the U.S. Supreme Court to review the ruling, but the Court declined. As a result, HHS’s guidance continues to be unenforceable in Texas.
Texas Sues Biden Administration to Block Federal Shield Law Protecting Medical Records
In early September, the Texas Attorney General filed another lawsuit against HHS to block a federal law that protects the medical records of women who cross state lines to seek legal abortions. The suit, filed in response to new HIPAA privacy rules that impose stricter standards on reproductive health care protected health information (PHI), accuses the federal government of attempting to “undermine” states’ law enforcement capabilities. Texas’s abortion ban exempts women from criminal charges related to their own abortion but does allow for private civil action and imposes criminal punishments on any person who assists a woman in obtaining an abortion. Developments in the case are pending.
Wisconsin Supreme Court Hears Arguments in Abortion Law Challenge
The Wisconsin Supreme Court heard arguments on Nov. 11, 2024 over whether a state law dating back to 1849 prohibits abortion. The law makes it a felony to kill an unborn child or the child’s mother with the intent of killing the unborn child; a 2023 circuit court ruling held that the law applied to feticide, not abortion. The Court also agreed to hear a separate case brought by Planned Parenthood requesting a ruling on whether the state constitution includes a right to abortion, but arguments have not yet been scheduled.
Mifepristone Lawsuit Resurrected in Texas District Court
On June 13, 2024, the U.S. Supreme Court declined to issue a ruling on the merits in of a challenge to the FDA’s approval of expanded access to Mifepristone (a commonly used abortion pill), holding instead that the groups that filed the lawsuit did not have standing because they could not show they were directly harmed by the FDA’s decision. As a result, access to Mifepristone remained in place. Now, three states are again challenging the FDA’s approval of expanded access to the drug.
On Oct. 11, 2024, the attorneys general of Missouri, Idaho, and Kansas filed a revised lawsuit against the FDA in the same federal district court in Texas where the original case was filed, again asking the court to reverse several FDA regulations that expanded access to Mifepristone. The revised lawsuit also requests new prohibitions, such as banning the medication for minors under 18 and restricting prescription access through telehealth and mail-order.
Lawsuit Brought Challenging Kentucky’s Abortion Ban
A lawsuit was filed on Nov. 12, 2024 in Kentucky against the state attorney general and other state officials by a woman currently seeking an abortion, prohibited by the state’s near-total ban, alleging that the ban violates the state constitution’s rights to privacy and self-determination. Kentucky currently has two laws in place restricting abortion, including one that prohibits abortion if a fetal heartbeat is detected (typically six weeks) except in cases of medical emergency, and another that bans abortion unless to prevent the death or substantial and irreversible impairment of a major bodily function of a pregnant woman. The state laws provide no exceptions for cases of rape, incest or fatal fetal anomalies/medically futile pregnancies.
California Sues Hospital Over Denied Emergency Abortion
The California Attorney General on Sept. 30, 2024 filed a lawsuit against a hospital alleging that it refused to provide emergency abortion care to women whose lives were in jeopardy in violation of the state’s Emergency Services Law. The suit claims that hospital policy bars doctors from providing life-saving or life-stabilizing emergency abortion treatment even when a pregnancy is not viable and that the hospital only allows the procedure if the mother’s life is in immediate danger of death, by which time it may be too late. The hospital and the California Attorney General’s office reached a temporary agreement as of Oct. 29, 2024, which stipulates that the hospital agrees to fully comply with the state law by allowing physicians to terminate a patient’s pregnancy if not doing so would seriously risk her health and by first providing emergency stabilizing care, including abortion, prior to transferring a patient to another facility.
Lockton comment: Legal challenges to state laws, the interplay of state and federal laws, and the application of those laws in practice continue to multiply across the nation, and, in the wake of the several ballot initiatives passed this November, only promise to increase. Lockton will provide updates on these cases to clients in our State-by-State Guide to Abortion Laws when available.
Other Updates to Abortion and Reproductive Care State Laws
Delaware passed a bill on Sept. 9, 2024 requiring individual and group health insurance, HMOs and Medicaid to cover abortion and abortion-related services without deductible, coinsurance, copayment, or any other cost-sharing requirements. Plans may not require referrals or prior authorization but may cap the benefit at $750 per participant annually. Certain types of limited coverage plans are exempt from the requirement, and HDHP and catastrophic plans are exempt from the cost-sharing prohibitions if they would cause them to lose status and treatment under federal law. Religious employers may obtain an exclusion from the carrier if the requirements conflict with the organization’s bona fide religious beliefs and practices, but services must be covered when the life or health of the covered individual is at risk. These changes are effective for private group, blanket and individual coverage for policies issued, renewed or altered after Dec. 31, 2025. These laws do not impact self-insured ERISA plans.
GENDER-AFFIRMING CARE AND TRANSGENDER BENEFITS
U.S. Supreme Court Schedules Oral Arguments in U.S. v. Skrmetti
As the nation awaits a decision from the U.S. Supreme Court in a case challenging the constitutionality of two state gender-affirming care bans stemming from Kentucky and Tennessee by next summer, we are looking with anticipation to the more immediate future as oral arguments have been scheduled for Dec. 4, 2024. The outcome of this case will prove to have a domino effect as several lawsuits challenging state prohibitions have been stayed pending the Court’s decision, including cases in Idaho and Indiana.
Florida Continues its Legal Battle Over Gender-Affirming Care Prohibitions
As we noted in our previous Alert (opens a new window), Florida’s state law prohibiting gender-affirming care was overturned by a district court judge in June 2024 but quickly went back into effect after the Eleventh Circuit Court of Appeals issued a stay on the lower court’s ruling while the state’s appeal continues. The appeals court has just released information that arguments in the appeal are scheduled for Jan. 15, 2025.
We also noted in our last Alert (opens a new window) that the same Eleventh Circuit Court of Appeals in early August 2024 agreed to re-hear its ruling from May holding that an employer’s health plan that does not cover treatment for gender dysphoria violates Title VII protections against discrimination on the basis of sex (see Lange v. Houston County). The rehearing order vacated the previous decision, and the entire panel of judges will reconsider the case. In the meantime, another Florida district court has stayed proceedings in a pending appeal based on the Lange rehearing. In its ruling from August 2024, the court held that Florida’s state employee health insurance plan also violated Title VII protections by excluding coverage for gender reassignment or modification services for transgender employees, relying heavily on Lange to support its ruling. It will now await a new ruling before proceeding with the appeal.
Lockton comment: The Eleventh Circuit Court of Appeals, which covers Alabama, Florida and Georgia, will prove to be significant in the battle over state gender-affirming care laws as it decides these two major Florida-based cases in the coming year. Between these rulings and the heavily anticipated U.S. Supreme Court ruling in Skrmetti, 2025 should provide some clarity in this hotly contested arena. We will remain apprised of updates and provide new information to Lockton clients in our State-by-State Guide to Gender-Affirming Care Laws.
Maine Court Rules Defense Department Must Cover Gender-Affirming Surgery
On Nov. 1, 2024, a district court in Maine ruled that the U.S. Defense Department violated Fifth Amendment equal protection laws by excluding coverage for gender-affirming surgery in the Department’s health plan. The statute establishing the TRICARE health plan used by the Department excluded coverage for any surgery that “improves physical appearance… without significantly restoring functions” and specifically noted “sex gender changes” or “any procedures related to sex gender changes” in the excluded benefits. Another regulation stated that TRICARE does not cover “any surgery performed primarily for psychological reasons (such as psychogenic).” The lawsuit argued that the exclusion was discriminatory because gender-affirming surgery was available under TRICARE for non-transgender enrollees for other reasons, such as removal of body parts for cancer treatments. The court agreed, holding that the exclusion violated equal protection rights and ordered the plan to meet with the plaintiffs to determine the appropriate relief.
Other Updates to State Gender-Affirming Care Laws
Texas Attorney General Sues Doctors for Providing Transgender Care to Minors
In a series of lawsuits, the Texas Attorney General has sued three individual physicians as of Nov. 8, 2024 for prescribing hormone treatment in violation of the state prohibition on gender-affirming care for minors, as well as allegedly misrepresenting diagnoses and using false billing codes in order to provide the treatments. The state ban took effect Sept. 1, 2023 but allows minors who began treatment before June 1, 2023 to continue receiving hormone therapy and puberty blockers in order to wean off of them over a period of time in a safe manner. The Attorney General affirmed that the state is now “cracking down” on doctors who continue to provide hormone treatments to minors after the ban’s effective date. The defendant physicians face monetary penalties and revocation of their medical licenses.
Lockton comment: These lawsuits against individual providers are the first of their kind in the nation; to date, no other states have sued providers for providing gender-affirming care to minors despite the many state prohibitions and penalties in place. There may be a chilling effect on providers’ willingness to offer transgender and gender-affirming health care services as a result.
Aetna Sued in Class Action Suit Over Denial of Gender-Affirming Care Coverage
Three transgender individuals filed a lawsuit in September claiming that Aetna discriminated against them by denying gender-affirming care coverage. The suit, filed in a Connecticut district court, alleges that Aetna refused to cover medically necessary gender-affirming facial reconstruction surgery despite covering other gender-affirming procedures such as breast augmentation and reconstructive surgery, and that it covers facial reconstruction for diagnoses other than gender dysphoria. Legal proceedings are pending.
Ohio and Idaho Accuse Pediatrics Group of Consumer Violations Over Gender-Affirming Care
In August 2024, the American Academy of Pediatrics (AAP) renewed its guidance supporting the use of puberty blockers, hormone therapy, and other medical care for transgender minors. In September 2024, the Idaho attorney general, joined by 20 other states, sent a letter to the AAP “demanding cooperation with an investigation into the advice they continue to offer” on gender-affirming care. The letter suggests that the AAP violated state consumer protection laws in supporting gender-affirming care for minors and requests that it turn over communications and documents detailing how its policy was developed.
Lockton comment: Like the Texas lawsuits against providers, the multi-state letter to the AAP may contribute to a chilling effect in this space as disputes continue to rage in the absence of clear guidance on whether such services are lawful. because of these lawsuits as well as the multi-state letter to the AAP. We expect to sit with further uncertainty until the U.S. Supreme Court issues its final word on the topic in 2025.
PHARMACY AND PBM REGULATION
U.S. Supreme Court Requests Opinion from Solicitor General in PBM ERISA Case
As an appeal from Oklahoma to the U.S. Supreme Court is pending certiorari (a decision on whether the Court agrees to review the case), the Court has directly requested that the U.S. Solicitor General file a brief expressing the government’s views, signaling a high likelihood that the Court will agree to take up the case. The Oklahoma appeal stems from a Tenth Circuit Court decision in 2023 holding that certain state laws regulating pharmacy benefit managers (PBMs) were preempted by ERISA and Medicare (see Mulready v. PCMA). Over thirty state attorneys general also filed a brief in June 2024 asking the Court to review the Tenth Circuit’s ruling. See our previous Alert (opens a new window) for more background on the Mulready case.
Texas Attorney General Opinion on Texas PBM Laws and ERISA Preemption Still Pending
In May 2024, Texas Senator Charles Schwertner submitted a letter to Texas Attorney General Paxton requesting opinions on whether two specific Texas laws generally imposing standards on health benefit plan issuers and PBMs acting on their behalf regarding employer plan designs and the manner in which they build networks of participating pharmacies are (1) enforceable against a PBM administering benefits under an ERISA plan (and against an ERISA plan “issuer”), and (2) enforceable against a PBM or issuer where the plan is domiciled outside of Texas and the plan provides coverage to Texas residents and the PBM contracts with a network of providers that include Texas pharmacy providers. The Attorney General had until Nov. 12, 2024 to issue an opinion, however the request status is still pending at the time of this writing.
PBMs Sued Over High Insulin Costs
The Texas Attorney General in October 2024 filed a lawsuit against PBMs, including CVS, Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx, as well as several leading insulin manufacturers, accusing them of collaborating to inflate the costs of insulin. The U.S. Federal Trade Commission (FTC) sued the same PBMs in September 2024, claiming that they steered diabetes patients toward higher-priced insulin in order to receive millions in rebates from pharmaceutical companies. Proceedings are pending, but the PBMs released statements indicating that the lawsuit is baseless.
State Bills Impacting ERISA Plans
The California legislature passed SB 966 in August 2024, which would have restricted the ability of ERISA plans to offer limited networks, home delivery, and exclusive specialty effective Jan. 1, 2025. However, the governor ultimately vetoed the bill. Colorado signed HB24-119 into law on June 3, 2024, which requires that prior authorization criteria must be posted on a public website and approvals for chronic medications can be for no less than three years. The law is effective for conduct beginning on or after Jan. 1, 2026.
Lockton comment: In 2024, there were over 100 new PBM bills introduced in state legislatures, and many states had carryover legislation introduced in 2023 that rolled over into the 2024 session as well, bringing the total to over 300 pieces of legislation being considered nationwide. As the nation continues to debate ERISA preemption in state attempts to regulate PBMs, we anticipate that the U.S. Supreme Court will likely weigh in next year, given its request for an opinion from the U.S. Solicitor General in the Mulready case and its involvement in the previous PBM cases forming the basis for the Mulready decision.
OTHER BENEFIT-RELATED UPDATES
California
Several new bills were passed in California with requirements for fully insured plans. These laws do not impact self-insured ERISA plans.
Gov. Gavin Newsom signed Senate Bill 729 on Sept. 29. 2024, increasing access to in vitro fertilization (IVF) and other infertility/fertility services beginning July 1, 2025. Plans must cover up to three cycles of oocyte (egg) retrievals and unlimited embryo transfers, and the bill includes a new definition of infertility that broadens access for the LGBTQ+ community. Self-funded, religious and small group employers are exempt.
California Senate Bill 1120, also passed in September, regulates the use of artificial intelligence (AI) tools to analyze medical necessity. The law requires that as of Jan. 1, 2025, determinations be based on an enrollee’s actual medical or clinical history and not solely on a group data set; that health care services may not be denied, delayed, or modified based on a determination made by an automated decision-making tool and that determinations only be made by a licensed physician or competent licensed health care professional.
Another coverage mandate, AB 2843, requires coverage for treatment of rape and sexual assault, including emergency room medical care and follow-up medical or surgical treatment with no cost-sharing and on a pre-deductible basis for nine months after treatment starts, effective July 1, 2025. Follow-up treatment coverage applies to services at in-network providers and emergency providers (but may extend to nonparticipating, nonemergency providers if access to in-network providers is unavailable). HDHPs are exempt from cost-sharing provisions to the extent that they would disqualify the plan from HSA eligibility.
Finally, CA AB 1048 will soon require dental plans to meet new coverage requirements and comply with state reporting metrics. Passed in October 2023, the law prohibits dental plans from denying claims related to a patient’s preexisting dental conditions and prohibits dental plans in the large group market from imposing arbitrary waiting periods before patients can access their full benefits. Beginning Jan. 1, 2025. dental carriers are required to report rate information annually on several metrics for state regulatory agencies to review to ensure consumers are protected from unreasonable or unjustified rates.
Illinois
Illinois followed California’s lead in enacting several insurance mandates this quarter. These laws do not impact self-insured ERISA plans.
The Health Care Protection Act, passed in July 2024, contains several requirements, including a ban on step therapy for mental and emotional disorders; a ban on the use of prior authorization for inpatient mental health services and concurrent review or retrospective denials for the first 72 hours after admission; drug formulary public posting requirements; network adequacy standards at least as good as Health Insurance Marketplace standards; and penalties for failing to maintain accurate network directories.
New IVF coverage requirements for plan years beginning in 2026 emerged from SB 773, directing plans to cover diagnosis and treatment of infertility, including IVF, and preimplantation screening and diagnosis of a fertilized egg in some cases. The state’s current fertility mandate only applies to the state employee plan or private plans with 25 or more employees, while the new bill expands coverage requirements to private employer plans, government plans, school plans, HMOs, limited health service organizations and voluntary health services plans. The bill also requires plans with more than 25 employees provide an annual menopause health visit for individuals 45 years of age and older with no cost-sharing. This provision does not apply to HDHPs to the extent that it would disqualify the plan from eligibility for an HSA.
Also similar to California, Illinois passed HB 2472, which outlines requirements in using AI tools for medical necessity determinations as of Jan. 1, 2025. The bill requires that even if a health care plan or other utilization review program uses an algorithmic automated process in the course of utilization review for medical necessity, it must ensure that only a clinical peer makes an adverse determination based on medical necessity and that any subsequent appeal must also be reviewed by a clinical peer. Any automated processes must use objective, evidence-based criteria compliant with accreditation requirements.
Several additional insurance mandates were passed in Illinois with effective dates ranging from Jan. 1, 2025 through Jan. 1, 2026, including a mandate requiring pregnancy-related coverage to include at least 12 months of postpartum care in addition to the currently required pregnancy and newborn care; a bill prohibiting prior authorization for receiving care from a licensed obstetrician or gynecologist; expanded dependent care coverage extending to parents and stepparents who meet the qualifying relative dependent definition; coverage for colonoscopies when deemed medically necessary with no age limitation or initial screening; and finally, short-term, limited-duration policies are banned in Illinois beginning Jan. 1, 2025.
Massachusetts
Like California and Illinois, Massachusetts passed a fertility mandate, requiring coverage for standard fertility preservation services when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage must be provided to the same extent it is provided for other pregnancy-related procedures. The law is effective retroactive to July 1, 2024 to align with the budget year.
Lockton comment: While Lockton generally does not track or publish guidance on insurance mandates, we wanted to bring your attention to the large volume of insurance bills and coverage mandates passed late this year in several states. As a reminder, these laws do not apply to self-insured ERISA plans; however, we recommend that employers stay engaged in state updates as they consider new benefit plan offerings to meet employee needs. Fully insured plans with further questions on the numerous and dense rules released this year are encouraged to reach out to carriers or legal counsel for further guidance.
Washington
Finally, Washington voters chose to uphold WA Cares, the state’s long-term care insurance program, by rejecting Initiative 2124 this November. The measure would have provided that that employees and self-employed people must elect to keep coverage under the program and could opt out at any time, but it failed to pass. Concerns over insolvency if the program became voluntary are quelled as the long-term care program remains in place with no changes at this time.
Lockton comment: Currently, Washington stands alone as the only state with a long-term insurance program; however, several other states are considering implementing similar programs with California, New York, and Pennsylvania purportedly moving quickly. The success of WA Cares in defeating Initiative 2124 may influence other states to push forward in enacting similar programs. Lockton will remain engaged on any developments and provide updates in our State-by-State Guide to Long-Term Care Mandates.
Not legal advice: Nothing in this alert should be construed as legal advice. Lockton may not be considered your legal counsel, and communications with Lockton's Compliance Consulting group are not privileged under the attorney-client privilege.
