Roundup of selected state health developments, third-quarter 2022 

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November 04, 2022

States revised, clarified and expanded leave mandates during the third quarter of 2022, with developments in California, Colorado, Connecticut, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Oregon, Rhode Island, Washington and Washington, DC. Changes affected paid family and medical leave (PFML), paid sick leave, unpaid leave and even paid military leave. California led the way in insurance coverage mandates as legislative sessions ended throughout the US. Regulators in Arkansas and Louisiana focused on additional pharmacy benefit manager (PBM) restrictions. California extended the period for COVID-19 supplemental paid sick leave and insurance coverage of COVID-19 testing. Washington finalized long-term care (LTC) insurance rules. Philadelphia adopted a commuter benefit mandate.

Download the 18-page print-friendly PDF to read the full coverage. Here are highlights of the topics covered.

Leave laws

During the third quarter, several jurisdictions focused attention on paid and unpaid time-off mandates. California and Washington, DC, expanded existing PFML programs, with California focusing on benefit amounts and the district focusing on duration. Regulatory activity occurred in three states starting programs next year, with Colorado and Oregon implementing mandatory programs and New Hampshire offering a voluntary program. Other states like Massachusetts, New York and Rhode Island announced 2023 contribution rates and maximum benefits. A pending Michigan case may change major aspects of its accrued paid sick leave requirement. California increased bereavement leave benefits and modified its paid military leave rules in response to wildfires. Connecticut and New Jersey revised general leave notice requirements.


California passed a flurry of legislation, including insurance mandates addressing issues like contraceptives, gender-affirming services, telehealth, mental health, prescription drugs and abortion. California also finalized rules related to the Summary of Dental Benefits and Coverage matrix (SDBC), with different effective dates depending on plan type. Other highlights include Rhode Island’s special enrollment for pregnant women and Washington, DC’s mandated coverage of medically necessary foods. Massachusetts set minimum creditable coverage (MCC) cost-sharing rates for 2023.

Prescription drugs

California will help manufacture some prescription drugs. Arkansas and Louisiana regulations clarified recent laws restricting PBM activities.


California is one of a few states still addressing COVID-19 concerns. The state recently enacted laws mandating coverage of COVID-19 testing and related services beyond the federal Department of Health and Human Services’ public health emergency (PHE) and extending supplemental paid sick leave (SPSL).

Other benefit-related issues

Washington has clarified provisions of a LTC law that will start to take effect next year. Also starting in 2023, many Philadelphia employers will need to provide a commuter benefit program, joining other municipalities with similar mandates, including New York City, San Francisco, Seattle and Washington, DC. Oregon issued guidance on association health plans (AHPs). San Francisco published its 2023 rates under its Health Care Security Ordinance (HCSO).

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