Mandated Health Insurance Benefits and State Laws

Mandated Health Insurance Benefits and State Laws

Updated: January 2011; material added February 2012

For more than two decades, state legislators have regularly debated and enacted "mandates" or required health coverage for specific treatments, benefits, providers and categories of dependents. States continue to debate whether such mandates actually ensure adequate protection for their constituents or further increase their health care costs.  Listed below are some useful resources and links that provide background, information and examples of state legislation regarding mandated coverage.

Federal Health Reform Law - the 2010 Affordable Care Act will have significant effects on existing state mandate laws.  Some mandate-style services will be assured of coverage in all 50 states under federal law.  Other state-specified mandates may not be covered within the American Health Benefit Exchanges that will coordinate health insurance offerings beginning in 2014. 
See NCSL Health Reform resource web site for more information

NCSL Tables and Other Documents

Please see topic specific pages (click to view):

• Autism
• Cancer Mandates and Exceptions
• Childhood Immunizations
• Clinical Trials Coverage
• Colorectal Cancer Screening
• Contraceptives
• Dependent Coverage
• Diabetes
• Infertility Treatment
• Mental Health Benefits
• Newborn Hearing Screening
• Newborn Genetic & Metabolic Disease Screening
• Submit a question to NCSL (Legislators and staff only)

NCSL Publications & Related Internet Sites

• State Insurance Mandates and the ACA Essential Benefits Provisions - Published July 2011.
• NCSL Managed Care Overview - Additional information, news and links for general managed care topics - 2011
• 2011 Enacted State Mandate Laws - a tally of new additions and changes for this years' sessions, updated July 2011.
• HMO State Laws - a 50-state compilation and summary. - 2009
• Health Insurance and Managed Care: Overview - 2009 
• Health Insurance Coverage Mandates: Are They Too Costly?  - An in depth look at current state mandate laws, totaling more 1,900 across all 50 states, and the recent initiatives to require cost and effectiveness reviews and design mandate-free and mandate-light alternatives.
• Overview of State Mandates, costs and exemptions for 2009.  NCSL presentation (.pdf) by Richard Cauchi for Louisiana Health Insurance Conference, May 2009.
  • The Role of Mandates for Consumers - Karen Bender, Oliver Wyman Actuarial Consulting.
  • Mandates: A view from Insurers - America's Health Insurance Plans (AHIP) - Presentation (.pdf)

State Mandate Studies and Evaluations

• California Health Benefits Review Program
• Colorado Legislative Council - Mandated Health Insurance Benefits, 2011
• Connecticut Review and Evaluation of Certain Health Benefit Mandates, 2012
• Hawaii Report of the Mandated Benefits Advisory Task Force, 2001
• Louisiana Mandated Healthcare Benefits Study, 2005-2007
• Maryland Annual Mandated Health Insurance Services Evaluation, 2011
• Tennessee Cost of State and Federally Mandated Health Benefits, 2011

Other Websites and Useful Links

California Health Policy Roundtable: Mandated Health Insurance Benefits: Tradeoffs Among Benefits, Coverage and Costs. (.pdf)

Council for Affordable Health Insurance: State Legislators' Guide to Health Insurance Solutions. (.pdf)

Blue Cross Blue Shield Association

Heritage Foundation- How Health Insurance Mandates Misdiagnose the Disease

National Center for Policy Analysis- Mandate-Lite Policies Piece (July 9, 2007)

National Alliance for the Mentally Ill- State Mental Health Parity Background Piece   and State by State Chart

State Coverage Initiatives (Robert Wood Johnson Foundation)- Report on Limited-Benefit Plans (mandate-lite).

*NOTE: NCSL provides links to other Web sites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.

This page compiled by Karmen Hanson; 2010 updates by  Richard Cauchi and Andrew Thangasamy - NCSL Health Program, Denver.