States increase focus on menopause-related conditions
Menopause and its related conditions have been a difficult reality for women for some time. Health plan coverage specifically addressing menopausal symptoms is a relative newcomer.
Unlike maternity care, menopause coverage is not included in the Affordable Care Act’s essential health benefit protections, so coverage of symptoms may vary widely. This is starting to change, particularly at the state level. So far, state legislation has focused on two main areas: health benefits and anti-discrimination laws.
Health benefits. Several states strengthened insurance requirements for perimenopause, menopause, and/or post-menopause this year, including: Illinois, Maryland, New Jersey, and Virginia. California mandated coverage of US FDA-approved treatments, including hormone therapy, GLP-1s, and low-dose antidepressants, as well as implementation of a program to ensure access to current menopause information and covered items and services, effective for 2027 plan years. These laws do not apply to self-funded ERISA plans. Bills in other states like Colorado and Missouri fell short in 2026.
Anti-discrimination laws. Last year, Rhode Island amended its Fair Employment Practices Act to require employers to make reasonable accommodations for menopause-related conditions. The Illinois law gives menopause-related conditions protected status under the state’s anti-discrimination laws, effective January 1, 2027. Philadelphia amended its Fair Practices Ordinance to include menstruation, perimenopause, and menopause among the conditions protected from employment discrimination and requiring reasonable accommodations, also effective January 1, 2027. However, a California bill that would have included these conditions within the definition of “sex” in the Fair Employment and Housing Act was vetoed in September. The governor reasoned that these conditions are already covered to the extent they rise to the level of a medical condition or disability.
The current federal landscape has potential protections for women, but nothing specific to menopause. For example, sex and disability discrimination are prohibited under Title VII and the Americans with Disabilities Act, but the latter would require a menopausal condition to be “an impairment that substantially limits one or more major life activities” to merit protection. Likewise, whether menopause qualifies as one of the “related medical conditions” under Title VII or the Pregnant Workers Fairness Act (PWFA) is an open question, determined on a case-by-case basis. However, several courts have applied Title VII protections to menstruation when it has a nexus to pregnancy or childbirth, and the PWFA’s definition of “related medical conditions” includes menstruation.
As 2026 winds down, it is a good time for employers to assess current coverage and employment policies. After all, October is Menopause Awareness Month. Employers sponsoring group health plans, especially self-funded ones, may want to review current plan design to ensure appropriate coverage of conditions related to peri-menopause, menopause and post-menopause, as well as access to providers specializing in these areas. A self-funded plan sponsor in a state with a benefit mandate may consider changes for recruiting and retention purposes. They may also consider working with a third-party vendor to improve access to specialized providers and educational resources, including telehealth or a full-service reproductive health product. In addition, educating colleagues and managers on menopause, symptom management and workplace supports can help strengthen the employee experience, while staying abreast of legislative developments in 2027 will be important for future planning.
