Roundup of selected state health developments, fourth-quarter 2021 

Front view of Caucasian female doctor examining mixed-race male patient neck in hospital
January 21, 2022

As 2021 came to an end, some state legislatures remained in session, and regulators stayed busy. Guidance in the fourth quarter addressed plan sponsor reporting for several states’ individual health coverage mandates and health plan details in Massachusetts. A new Illinois law requires certain employer health plan disclosures. The focus on prescription drug costs continued, with a transparency report in California and pharmacy benefit manager (PBM) laws in Delaware, North Carolina, and North Dakota. Delaware and Ohio enacted new insurance mandates, and New York introduced a COVID vaccine cost-sharing bill for insured plans. State paid leave laws garnered much attention, with some jurisdictions updating benefits and contributions for 2022 and others drafting regulations or clarifying current law. Other benefit-related issues involved Colorado’s benchmark plan, Connecticut’s health plan identification cards, Massachusetts’ tax limits for transit benefits, New York City’s employee vaccine mandate, and Washington’s long-term care mandate, which is now in limbo and the subject of a federal lawsuit.

Download the 12-page print-friendly PDF to get full details. Here are highlights of the coverage.

Health plan reporting

Several states updated or enacted reporting obligations for plan sponsors near the end of 2021. California, New Jersey and Rhode Island posted updates for self-funded plan sponsors, health insurers and other providers of minimum essential coverage (MEC) that must report to the state. Illinois enacted a new mandate requiring employers to disclose to employees in the state how the employer’s plan compares with the state’s essential health benefits (EHBs). Massachusetts reminded employers to submit an annual Health Insurance Responsibility Disclosure (HIRD).

Prescription drugs

California has issued a prescription drug report showing, in part, a 15% spending increase over four years. Delaware has stepped up its PBM pricing restrictions, network adequacy requirements and reporting as part of a new law. North Carolina has joined a growing number of states requiring PBMs operating in the state to obtain a license. Citing a US Supreme Court ruling, a federal appeals court upheld a North Dakota law regulating PBMs that faced an ERISA challenge.


Delaware has enacted a first-dollar coverage mandate for insulin pumps. Legislation introduced in New York would impose certain cost-sharing requirements for COVID-19 vaccines. A new Ohio law requires parity in cost sharing and coverage for telehealth and in-person services. None of these laws applies to self-funded group health plans.

Paid leave

States with paid family and medical leave (PFML) and disability benefit laws posted contributions and benefits updates for 2022. California, Connecticut, Hawaii, New Jersey, New York, Rhode Island, Washington, and Washington, DC, have recently posted updates (updates from Massachusetts were covered in the last quarterly roundup). New York also added siblings as family members under the paid family leave law, beginning in 2023. Colorado has begun developing regulations for the state’s voter-approved PFML program and updated regulations banning use-or-lose vacation accruals. Massachusetts has revised the written notice of PFML benefits that employers must distribute to workers in the state. Oregon has begun the regulatory process for its delayed PFML program.

Other benefit-related issues

Colorado has updated its essential health benefits (EHBs) to include gender-affirming care, raising dollar limits for plans using the state’s benchmark and covering related treatments. Connecticut now requires health carriers and third-party administrators operating in the state to include on identification cards whether the plan is self-funded. Massachusetts has set 2022 tax exclusion limits for transit benefits that differ from the federal limits. New York City has updated its COVID-related FAQs on workplace vaccine requirements. Washington abruptly halted implementation of its long-term care (LTC) program and won’t collect premiums for the first quarter. The program’s fate and the employee contribution status remain in limbo, while a lawsuit seeks to stop the mandate from taking effect.