The votes are in: How benefits-related ballot initiatives fared 

Tuesday, Nov. 5 was a monumental day at the polls across the country. The same held true for four statewide ballot initiatives. The final tally: three home runs and a strikeout.

Paid Sick and Safe Leave mandates passed easily in Alaska, Missouri and Nebraska. Meanwhile, a Washington vote failed that could have meant the beginning of the end for the WA Cares Long-Term Services and Supports mandate. Alaska and Missouri also approved minimum wage increases.

Let’s look at the PSSL box score:

• Accrual rate: One hour for every 30 hours worked (all three states).
• Annual accrual cap: 56/40 hours (AK: 15+/<15 employees; MO: none; NE: 20+/<20).
• Annual usage cap: 56/40 hours (AK: 15+/<15 employees; MO: 15+/<15; NE: 20+/<20).
• Carryover: All three states require it. Missouri allows an 80-hour cap. Alternatively, Missouri and Nebraska allow an end-of-year payout plus frontloading at the start of the next year.
• Payout of unused leave at termination. None of the states require it.
• Qualifying reasons other than sickness. Alaska and Missouri cover circumstances related to domestic violence, sexual assault or stalking. Missouri and Nebraska cover school and business closures related to a public health emergency, as well as isolation orders.
• Effective dates: Alaska: July 1, 2025; Missouri: May 1, 2025; Nebraska: Oct. 1, 2025.

Here are the highlights of the ballgame in Washington.

As background, the LTTS program funds a Long-Term Care benefit for covered individuals of up to $36,500 lifetime max (indexed for inflation). Employees who do not have an exemption must contribute 0.58% of wages, deducted from their paycheck (with no cap). Employers do not have to contribute. Benefits first become available for eligible individuals on July 1, 2026. A vesting schedule applies; a shorter time frame is allowed for individuals born before Jan. 1, 1968.

An approved ballot initiative would have allowed employees and self-employed individuals to opt out of contributions at any time and would have repealed the exemption for employees who purchased LTC insurance before Nov. 1, 2021. With this kind of optional funding, the LTTS program’s future would have been in serious doubt absent additional legislative action. Details on the program are available on the Employee Security Department webpage and our GRIST: Washington changes long-term care law.

So what do these results mean for next season?

Clearly, enacting a PSSL law by ballot appears much easier than the legislative route. The margins in all three states were by double digits, almost 3-to-1 in Nebraska. PSSL bills in various states did not come close to passage during the 2024 legislative cycle. PSSL is now the law of the land in 18 states and Washington, DC and Puerto Rico with paid leave for any reason in another three states. We can reasonably expect more debate and discussion next year, both in the statehouse and at the ballot box.

The future for LTC coverage mandates in states besides Washington remains unclear at this point. The few bills that have been introduced in recent years have failed to gain traction, even though LTC costs are putting an increasing strain on state Medicaid programs.