Assessment of Fiscal Notes Connected to Motorcycle Helmet Legislation

Anne Teigen, Erica MacKellar and Douglas Shinkle 7/13/2016


The popularity of motorcycling as a transportation option and recreational pursuit continues to increase in the United States. The number of registered motorcycles in the U.S. is slightly below historic highs, with more than 8.4 million registered motorcycles as of 2014, according to the U.S. DOT’s Bureau of Transportation Statistics. This is up from 4.3 million in 2000.

There were 4,586 motorcyclist fatalities in 2014, according to the most recent data from NHTSA. Early analysis of 2015 data by the Governors Highway Safety Association, however, indicates motorcyclist deaths may have topped 5,000, which would be an increase of more than 10 percent from 2014 and the highest number of motorcyclist fatalities since 2008.

Given the large number of motorcyclists together with the persistent number of motorcyclist deaths and injuries, states continue to focus on creating a safe riding environment for motorcyclists. This manifests itself in a number of ways, including most prominently through public education and awareness campaigns, rider training, lighting, operation and equipment requirements, and helmet laws.

This report focuses specifically on motorcycle helmet legislation, examining to what extent legislative fiscal notes, which provide an estimate of the effect a bill will have on state revenues and expenditures, have been utilized to help project and calculate the economic costs and benefits of various state motorcycle helmet legislation. It is important to note that the methodology and data sources used to prepare fiscal notes vary widely by state.

Economic Impact of Motorcycle Crashes

Man wearing helmet riding a motorcycle.

NHTSA annually provides information on the number of lives saved by the use of DOT-compliant motorcycle helmets, as well as the potential number of lives that could have been saved by 100 percent helmet use. In 2013, an estimated 1,630 lives were saved because motorcyclists were wearing helmets. An additional 715 lives could have been saved if all motorcyclists had worn helmets. It is estimated that 41 percent of fatally injured motorcyclists in 2013 were not wearing a helmet. NHTSA also estimates the economic costs associated with motorcycle crashes, which represent the tangible losses resulting from a crash and the value of resources that are used to restore crash victims to their pre-crash physical and financial status.

These costs include:

  • Medical care
  • Lost productivity
  • Legal and court costs
  • Insurance administrative costs
  • Workplace costs
  • Travel delay
  • Property damage

Comprehensive costs are made up of these economic costs plus the estimated costs associated with lost quality of life. A total of 4,381 motorcyclists died in crashes in 2013. After adjusting for inflation, NHTSA estimates that the economic cost to society for each motorcyclist fatality was $1.48 million, and the comprehensive cost of each fatality was $9.71 million.

Study Results of Average Hospital Charges per Crash Victim by Helmet Status

A 2009 University of Wisconsin School of Medicine article in the Journal of Public Health Policy found that many researchers had studied the cost of an average hospital stay per motorcycle crash victim. In all of the studies, the cost of a hospital stay was higher if the rider was not wearing a helmet.


Average hospital charges per crash victim by helmet status.

Source: “Motorcycle helmets and rider safety: A legislative crisis”, Derrick and Faucher University of Wisconsin School of Medicine and Public Health. 


The studies that looked at motorcyclists admitted to hospital showed that almost half of all motorcyclists lack health care insurance or are covered by governmental health care services.


Payer distribution for hospital-admitted motorcycle crash victims. 

Source: “Motorcycle helmets and rider safety: A legislative crisis”, Derrick and Faucher University of Wisconsin School of Medicine and Public Health. 


History of Motorcycle Helmet Laws

In 1975, motorcycle helmets were mandatory for all riders (known as “universal helmet requirements”) in 47 states and the District of Columbia, in large part because federal highway funding was tied to universal helmet requirements. With the congressional removal of that requirement in 1976 and the more recent repeal in 1995 of financial incentives for universal helmet laws, six states—Arkansas, Florida, Kentucky, Louisiana, Pennsylvania and Texas—have relaxed their motorcycle helmet laws. In 1997, Arkansas and Texas became the first states since 1983 to repeal laws requiring all motorcyclists to wear helmets. Florida repealed its mandatory helmet law in 2000 and Pennsylvania followed suit in 2003. Louisiana weakened its motorcycle helmet use law in 1999, but re-enacted it in 2004.

Source: NCSL 2016

As of March 2016, 19 states, the District of Columbia, Guam, the Northern Marianas Islands, Puerto Rico and the U.S. Virgin Islands require all riders to wear helmets. Another 28 states require helmet use for certain groups, typically those under age 18 or under age 21. The laws in Florida, Kentucky, Michigan and Texas carve out exceptions to helmet use for motorcyclists over age 21 who carry a certain amount of insurance or who pass a safety course or both. Three states—Illinois, Iowa and New Hampshire—have no helmet requirements. Through its nationwide National Occupant Protection Use Survey (NOPUS), NHTSA estimates that about 64 percent of motorcycle riders used a DOT-compliant motorcycle helmet in 2014.

Laws requiring every rider to wear a helmet, known as “universal helmet” laws, are extremely controversial. The American Motorcyclist Association strongly encourages the use of personal protective equipment, including gloves, sturdy footwear and a properly fitted motorcycle helmet but it “believes that adults should have the right to voluntarily decide when to wear a helmet but does not oppose laws requiring helmets for minor motorcycle operators and passengers.” Other groups adamantly argue that helmet laws curtail personal liberties and should not be passed at all.

Proponents of universal helmet laws contend injuries sustained as a result of riders not wearing helmets is a public health crisis. Each year lawmakers in many states consider universal helmet law bills and, to the contrary, bills that would allow drivers in some circumstances to ride legally without wearing a helmet. As these heated debates in statehouses continue, legislators look to a variety of resources in making their decisions on whether or not to vote for motorcycle helmet legislation. One of these resources is the legislative fiscal note. This report will give an overview of how states use fiscal notes and provide an in-depth examination of the fiscal information eight state legislatures considered when motorcycle helmet laws were debated in their state.

What Is a Fiscal Note?

Thousands of bills are introduced in the legislature each year and a large number of them will have a fiscal impact on the state. For sponsors of these bills, one of the most important steps in the legislative process is the attachment of a fiscal note, often viewed as a bill’s “price tag.” The way legislative staff prepare and present fiscal information on a proposed bill can greatly affect the bill’s chance of passage.

A fiscal note provides an estimate of the effect a bill will have on state revenues and expenditures. A bill with a fiscal impact may increase or reduce expenditures, increase or decrease the revenues of an existing tax, change personnel requirements, affect levels of service, impose or shift a tax to a new base, or change the funding of an existing program. For example, if a bill proposed to require every motorcycle rider to take a state certified training course, the fiscal note of that bill might include how much revenue the state might receive from everyone signing up for the course and the cost to the state to administer the test.

Fiscal notes are important tools to help legislators balance the budget and, while they are widely used, there is no standardized fiscal note process, and every state approaches them differently. Most often, states rely on legislative fiscal staff to prepare fiscal notes. In some states, executive agencies prepare fiscal notes, and in a few states the process involves both the legislative and executive branches.

The determination of which bills require fiscal notes also varies from state to state. For example, every bill in Utah receives a fiscal note from the Office of the Legislative Fiscal Analyst. In Mississippi, fiscal notes are prepared only upon request, by either the bill author or the committee considering it.

Fiscal note authors usually evaluate the direct impact a proposed law will have on state revenues and/or expenditures for the current and subsequent fiscal year. In some cases, fiscal analysts may attempt to forecast out revenues and expenditures for a longer time-frame.

There are limitations to the static estimates typically used in fiscal notes, however. They usually estimate only the direct costs to the state, and do not measure impacts associated with indirect costs or induced behavior changes. They measure the near-term cost to state government, but do not incorporate long-term costs or benefits to government, citizens and society. For example, if a state invests in infrastructure, there could be long-term benefits to citizens and businesses, which could in turn generate more corporate tax revenue, but a fiscal note will only reflect the near-term cost to the state budget. In theory, the benefits of a more forward looking type of cost-benefit analysis are clear—it provides a more complete picture of the effects of policy changes on the economy. In practice, however, most states that have experimented with this type of analysis have found it to be impractical and imprecise. Fiscal analysts often lack sufficient data, time, staff resources and economic forecasting tools to accurately incorporate this type of impact analysis. In some states, however, analysts will include written commentary with a fiscal note, and they might delve into some of the possible effects of legislation on local governments, citizens and the business community, among other things. 

Fiscal Notes and Motorcycle Helmet Laws

Fiscal note writers consider a variety of factors when analyzing the fiscal impact of motorcycle helmet legislation. Oftentimes, the fiscal note will determine that there is no additional cost to the state to require motorcycle helmets, or to remove motorcycle helmet requirements. Sometimes this neutral fiscal note is because agencies that would be affected can absorb the changes within their existing budgets. Additionally, many states only estimate direct costs to a state, so they do not attempt to forecast out any costs that might result from increased or decreased injuries or fatalities related to motorcycle crashes and other factors.

Other states do include more in-depth analysis in their fiscal notes. These states will often discuss the impact of increased or decreased motorcycle accident injuries on social service programs such as Medicaid.

Below is an in-depth assessment of fiscal notes from eight states that considered motorcycle helmet legislation in the 10-year period from 2005 to 2015. These examples are provided to demonstrate what information state legislative bodies have considered when motorcycle helmet legislation has been debated in their state. The fiscal notes examined include states that provide only direct estimates on state revenues and expenditures as well as states that expand the analysis in an attempt to determine more long-term effects.

Michigan (SB 291 – 2012 – Enacted)

Fiscal note considered increased insurance premiums and Medicaid costs.

Michigan’s amendment of its helmet law in 2012 provides a case study of what information was considered in the fiscal notes when the bill was being debated, and also information a few years after the law’s passage showing how the law affected the state. 

Before the enactment of 2011 Senate Bill 291, Michigan had a universal helmet law. SB 291 amended state law to allow motorcycle riders over age 21 to ride without a helmet, provided they have $20,000 per passenger in first-party medical benefits payable in the event they are involved in a motorcycle accident. Riders also must have had their motorcycle endorsement for at least two years or passed a safety course.

The Michigan House and Senate both prepared fiscal notes for SB 291. Both fiscal notes estimated that state and local governments could experience increased operational costs because of increased insurance premiums, and that Medicaid could experience additional costs because there is a potential of more injuries with lower helmet usage. The notes also pointed out that

“By eliminating the requirement for operators of motorcycles to wear crash helmets, local and state law enforcement would no longer be able to issue tickets for operation of a motorcycle without a helmet. When tickets are written under state statute, the civil fine revenue goes to libraries. If a ticket is written under a local ordinance, the civil fine revenue is split between the local court funding unit and the local government.”

The House fiscal note went on to provide background and discussion of the bill, including arguments for and against the bill. Proponents of SB 291 argued that historically, insurance rates do not decrease when helmet laws are enacted or are repealed or modified and that motorcyclists injured in accidents are no more likely to be a public burden as a result of a traumatic accident than the general population. They also argue that the easing of the helmet requirement would have a positive effect on the state’s tourism economy because the current law discourages out-of-state riders from traveling to Michigan. Opponents of easing the universal helmet requirement argued that allowing riders to ride without helmets will increase motorcycle related fatalities, serious injuries, Medicaid expenditures and the cost of health and auto insurance for all residents in the state. Opponents cited Michigan’s constitution that says

“The public health and general welfare of the people of the state are ... matters of primary public concern. The legislature shall pass suitable laws for the protection and promotion of the public health.”

It was also noted that this law had actually been passed before—in the 2005-06 and 2007-08 legislative sessions—but they were both vetoed by the governor. Senate Bill 291 was passed and signed into law by the governor on April 17, 2012. 

Since the passage of Michigan’s universal helmet repeal, there has been extensive research and assessments on helmet use rates, injury and crash rates and insurance costs in an attempt to quantify the impact of the law change.

The Michigan Office of Highway Safety Planning, in conjunction with Wayne State University conducted a direct observation survey of motorcycle helmet use in 2013, one year after the law change. Helmet use by riders and passengers was monitored at 167 roadside locations throughout the summer of 2013. Helmet use information and data were collected for motorcycle type, as well as gender, age, and race of each observed rider. The study found that helmet use rate at randomly selected roadside locations was 73 percent in 2013, down from 99.4 percent in 2006, and the rate at motorcycle events and rallies was 58.8 percent. The study did note that helmet use in Michigan was 13 percentage points higher than the 60 percent national average from 2012.

A study that appeared in the American Journal of Surgery concluded that non-helmeted motorcyclists who were in crashes in Michigan more frequently died at the scene of the crash, spent more time in the intensive care unit and had higher medical costs than helmeted riders in crashes. The study noted that of 192 injured motorcyclists studied, medical expenses for injured helmet less riders averaged $32,700 compared with $21,300 for those who were wearing helmets.

Advocates of the relaxed helmet law have noted that the number of motorcyclist fatalities actually declined in 2014 to 112 deaths, compared to 138 in both 2012 and 2013 respectively. It is important to keep in mind that there are a number of factors that determine motorcyclist fatalities including number of riders, vehicle miles driven, weather, enforcement of traffic laws, education, etc.

The Highway Loss Data Institute found the average insurance payment on a motorcycle injury claim rose substantially in Michigan after the passage of SB 291. The study compared insurance company losses under medical payments and collision coverage during the 2010 and 2011 riding seasons (May through September) and the 2012 season, after the law was passed. The losses were also compared with losses in neighboring states like Wisconsin, Illinois, Indiana, and Ohio that had not changed their motorcycle helmet laws. Medical payment costs for motorcycle riders were 50 percent higher than expected after Michigan’s law change with most of that stemming from an increase in claim severity which may indicate that crashes after the law change resulted in more severe injuries as a result of less helmet use.

How Michigan medical payment losses changed after the state weakened its helmet law versus control states

Source: “Motorcycle helmets and rider safety: A legislative crisis”, Derrick and Faucher University of Wisconsin School of Medicine and Public Health. 

Maine (HP 69 - 2013 – Failed) 

Fiscal note considered cost to state judicial department to process anticipated violations.

Maine’s motorcycle helmet law requires only riders who are 17 and younger to wear a helmet. In 2013, the state introduced a universal helmet bill. The bill included a general fund appropriation to pay for a part-time assistant clerk position for the judicial department to process the anticipated increase in the number of violations that would have to be processed by moving to a universal helmet law. For the first year, the appropriation would have been $12,002, with $28,007 for the second year. Projections for the following fiscal years predicted slight increases for salary and came to $28,848 and $29,714.

The fiscal note reported that the bill would result in an expected increase in fine revenue by $130,000 annually.

Nebraska (SB 52 2011 - Failed)

Fiscal note considered costs to change designation on driver’s license and to change highway signage.

Nebraska currently has a universal helmet law. In 2011, the state considered, but did not pass, legislation that would have allowed anyone age 21 and over to ride without a helmet. The bill also provided that riders over age 15 but less than age 21 would not have to wear a helmet while riding if they completed a motorcycle safety education course. Riders who would have been exempted from the helmet requirement would have the words “helmet not required” printed on their driver’s license.

The fiscal note included:

  • A DMV estimate of a one-time expenditure of $32,000 in FY 2011-12 for computer programming expenses for the vendor to change the motorcycle operator’s license to include the words “helmet not required.”
  • A Department of Roads estimate that, if the bill passed, there  would be a one-time cost of $14,800 in FY 2011-12 for new signage and labor to replace existing highway signs that notify motorists of motorcycle helmet laws.
  • An estimated total expenditure related to this bill of $46,800.

The Legislative Fiscal Analyst in Nebraska, which issued the fiscal note, agreed with the assessment from the agencies. 

West Virginia (SB 356 2015 – Failed)

Fiscal note considered how much it would cost the state to provide more motorcycle safety classes and to issue exemption stickers.

West Virginia currently has a universal helmet law. In 2015, the state considered, but did not pass, a bill to provide a motorcycle helmet exemption to cyclists who are at least 21 years of age that had held a motorcycle operator’s endorsement for two years or completed a motorcycle safety training class. The motorcycle operator would have also been required to have health insurance with $10,000 in medical benefits. Motorcycle operators who were 21 years of age with a motorcycle endorsement on or before June 30, 2016, and that met the health insurance requirements would have been grandfathered. The fiscal note considered the following:

  • The Division of Motor Vehicles’ Annual Report for fiscal year 2014 showed 55,960 registered motorcycles in West Virginia. The division’s Motorcycle Safety Program estimated that about 27,500 of those individuals who owned motorcycles would have opted to be grandfathered into the helmet exemption.
  • The Motorcycle Safety Coordinator estimated that an additional 750 individuals would enroll each year in the motorcycle safety classes in order to receive the exemption. To cover the cost of the additional enrollees, the bill would have increased the motorcycle safety fee attached to the Class G motorcycle registration fee from $6.50 to $10. The revenue collected would be deposited to the Motorcycle Safety Special Revenue Account.
  •  To offset the cost of issuing the helmet exemption sticker, the bill authorized a $5 fee to be collected for each sticker. The sticker would expire two years after being issued. Revenue collected from the sticker would be deposited to the Road Fund.
  • The division estimated the cost to issue the sticker to be approximately $351,515 the first year, and an estimated $287,265 each year thereafter. Revenue generated from the sale of the sticker would be $337,110 the first year and $199,610 each year thereafter. Overall, the state expected revenues to outweigh costs in the first year of implementation, but to have a slight cost to the state in the following years.
  • Annual increase in the collection of Motorcycle Safety fees were estimated to be $195,860. For each student attending the Motorcycle Safety Classes, the state pays $125 per student. The 750 additional students per year would cost $93,750.

This fiscal note primarily lays out provisions in the bill concerning administrative costs to the state related to a motorcycle helmet exemption. As a result, the estimated cost of this bill to the state was minimal. 

Montana (HB 534 2007 - Failed)

Fiscal note considered revenue from citations.

Montana debated a universal law in 2007 and in the fiscal note, they noted the proposed legislation would have a positive impact to the general fund because revenue would be generated by issuing citations to those not wearing a helmet as required.

The analysis included the following:

  • 1. It was assumed that the fine would be $50.
  • 2. The Montana Highway Patrol estimated that it would issue 2,520 citations per year for violations.
  • 3. Total fine revenue would be $126,000 ($50 x 2,520 citations) per year based upon the first two assumptions.
  • 4. Half of the fine amount would go to the state general fund, and the other half to the county that the Montana Highway Patrol citation was issued in. 

Washington (HB 2495 2013 - Failed)

Fiscal note considered costs to law enforcement, county coroners and medical examiners.

Washington has a universal helmet law that requires all helmets to have a sticker certifying that it is in compliance with federal standards. The Washington Highway Patrol states on its website that “Legal helmets are designed to save lives while others are sold as novelty items only and never intended to be used on the road. In a collision, these ‘novelty’ helmets provide almost no protection for the rider.” In 2013 they considered a bill that would get rid of the requirement that the helmets have stickers.

This legislation was put forth by a motorcycle rights organization that argued this law resulted in a large number of “pre-textual” helmet inspection stops by law enforcement that profiled motorcyclists.

In the fiscal note, the Washington State Patrol noted:

  • If motorcycle helmets do not have to meet safety standards there may be more serious injury or fatality collisions for the Washington State Patrol to investigate. They were unable to determine the number of additional investigations.
  • An estimate that a motorcycle collision with a serious injury may take an average of four hours to investigate. Given an estimate that the cost would be $41.87 per regular time hour for a 10-year- trooper, with 4 percent education incentive pay, that would equate to a total of $167.48 per investigation.
  • For a fatality collision there would typically be three troopers present. At the rate of $41.87 per regular time hour for a 10-year trooper, with 4 percent education incentive pay, that would equate to $167.48 per person, times three troopers, for a total of $502.44 per investigation.

In the Local Government portion of the fiscal note, it was noted:

The legislation could result in higher costs for city and county law enforcement, county coroners and medical examiners, and public hospitals. The magnitude of these increased costs is indeterminate as the number of serious accidents involving helmets that do not meet federal safety standards (commonly known as ‘novelty helmets’) cannot be estimated.

  • In 2013, the Washington Association of Sheriffs and Police Chiefs (WASPC) estimated that the same number of hours are required for law enforcement officers responding to accidents on county roads and city streets. Because the WSP has more expertise investigating motorcycle accidents, they are often called to respond to those that occur on nonhighway roads as well.
  • In addition to costs for law enforcement, there would also be costs for county coroners and medical examiners related to increased number of autopsies each year. According to the Kitsap County Coroner's Office in 2013, the average cost for an autopsy conducted by their office is between $1,300 and $1,400.
  • There could be additional costs for Washington's public health districts, related to emergency care and serious injury recovery. According to the CDC, slightly more than half of motorcycle crash victims have private health insurance coverage. For patients without private insurance, a majority of medical costs are paid by the government. Some crash patients are covered directly through Medicaid or another government program. Others, who are listed by the hospital as “self-pay” status, might eventually become indigent and qualify for Medicaid when their costs reach a certain level.

Maryland (SB 612 – 2015 – Failed)

Fiscal note considered the revenue decreases because of a reduction in the number of citations issued for failure to wear a helmet and possible state Medicaid expenditures.

Maryland has a universal helmet law and a violation of the helmet law is a misdemeanor subject to a maximum fine of $500. Violators can choose to pay a prepayment penalty assessed by the District Court of $110 if they do not go to court. In 2015, the state considered Senate Bill 612, to exempt riders who are over age 21 and who carry at least $10,000 in health insurance coverage from having to wear a motorcycle helmet. The fiscal note provided information on how a decrease in the number of motorcycle helmet citations would reduce state revenue and how much the state may have to pay in Medicaid for drivers not wearing a helmet involved in a crash.

The note also included information from the Maryland Institute for Emergency Services on how many patients involved in motorcycle crashes were treated by the state’s trauma centers.

  • State Revenues: The fiscal note found that, if the bill goes into effect, general fund fine revenues would decrease beginning in fiscal 2016 because of a reduction in the number of citations issued for failure to wear a helmet. In fiscal 2014, 262 citations were issued statewide for failure to wear a helmet or eye-protective device while riding on or operating a motorcycle. Of these citations, 80 (30.5 percent) were prepaid, 81 (30.9 percent) went to trial, and 101 (38.6 percent) remained open as of January 2015. The citation carries a prepayment penalty of $110, including court costs. The fiscal note stated that the actual decrease in general fund fine revenues could not be reliably estimated and depended on the number of individuals who obtained the required health insurance coverage.
  • State Expenditures: Medicaid expenditures (50 percent general funds, 50 percent federal funds) were estimated to increase in fiscal 2016 to the extent that the exemption from the protective headgear requirement resulted in a reduction in helmet use and an associated increase in head injuries to crash-involved motorcyclists not otherwise covered by insurance. (A fiscal note for a similar bill introduced in Maryland in 2009 also mentioned costs to the state’s Developmental Disabilities Administration, because people under age 21 with traumatic brain injuries are eligible for DDA services.)
  • Emergency Services: The Maryland Institute for Emergency Medical Services Systems reported that Maryland’s trauma centers treated 1,094 patients involved in motorcycle crashes during fiscal 2014. Of these patients, 346 (32 percent) sustained a head injury, 20 of whom subsequently died. Of the 346 riders who sustained head injuries, 261 (75 percent) were wearing a helmet, 70 (20 percent) were not, and it was unknown whether 15 of the patients wore a helmet or not. All 346 required treatment, and 191 were admitted. Forty (21 percent) of the admitted patients stayed in the hospital for one day. Thirteen of the admitted patients required hospitalization for more than 28 days. The fiscal note also noted that there would be no fiscal effect to localities and a potential but minimal effect on small business. 

Missouri (HB 523 – 2015 –Failed)

Fiscal note considered the costs to state agencies related to an increase in traumatic brain injuries.

Missouri has a universal helmet law but in 2015 the legislature considered House Bill 523, which would have amended the law to allow riders with motorcycle insurance, and health insurance that includes personal injury protection of at least $50,000 in the case of a motorcycle crash, to ride without a helmet. The bill would have required adult riders with instruction permits and riders who were under 21 to wear a helmet.

The fiscal note reported that there would be no estimated effects on general revenue, other state funds, federal funds or local government. Additionally, officials from state agencies including the Department of Insurance, Financial Institutions and Professional Registration, Office of the State Courts Administrator, the Missouri Highway Patrol, the Department of Transportation, the Department of Corrections, and the Department of Revenue reported the bill would have no fiscal impact on their respective organizations.

A few state agencies did have some estimates on how the bill may affect them.

The Department of Health and Senior Services (DHSS) in Missouri stated that changing the helmet law would increase the number of adults incurring a traumatic brain injury, and that would result in an increase in participants requesting services through the Adult Brain Injury (ABI) Program.

  • Based on 2012 motorcycle crash statistics, population estimates of riders who are over 21, estimates of how many riders wear helmets in states with no helmet laws, and eligibility requirements of the ABI program, the fiscal note estimated there would be approximately 207 new enrollments to the ABI program per year.
  • The current average cost per participant to provide rehabilitation services through the ABI Program is $5,200 per year. The total needed for rehabilitation services would be $1,076,400 ($5,200 x 207 participants). The increase in participants would also require the ABI Program to add five additional service coordinators, based on the fact that currently there is an average of 40 participants per service coordinator caseload. The total needed for all five additional service coordinators would be $309,000 ($61,800 x 5 service coordinators).
  • The total needed to cover the costs for the additional participants would be at least $1,385,400 per year. However, the ABI program is based on available funding, so it is not required that the state appropriate additional funds to the program, and any new enrollees could be added to a waitlist for services.

The Department of Social Services Missouri Health Net Division estimated there would be 20 additional head-injury cases each year if the helmet law was repealed for people age 21 and over. It estimated that two of these cases would be uninsured and require initial and ongoing health care. The fiscal note then went on to calculate how much it would cost the Missouri Health Net program to reimburse hospitals to pay for the initial and ongoing care if there are two serious uninsured head injury cases a year and they both survive.

The estimated costs were:  

  • FY 2016: Two un-helmeted individuals would be injured because of a motorcycle accident and be eligible or become eligible for MO Health Net services. The initial hospitalization would be $22,149 per person ($22,149 x 2 = $44,298). The ongoing medical costs would be $14,364 per person for the year. Total annual cost to MHD was estimated at $73,026. For fiscal note purposes, they assumed a 10-month cost of $68,238 ($25,028 GR).
  • FY 2017: Assuming both FY ’16 injured people survive, the estimated cost for FY ’17 for those patients would be a full year (12 month) of ongoing medical costs but not including the initial hospitalization costs. In addition, for the two new people estimated to be injured in FY `18 there will be the initial hospitalization cost and on-going medical costs, inflated by 5.09 percent annually. Total cost is $106,932 ($39,219 GR).
  • FY 2018: Assuming all FY ’16 and all FY ’17 injured people survive, the estimated cost for FY ’18 for these patients would be a full year (12 month) of ongoing medical cost but not including the initial hospitalization costs. In addition, for the two new people estimated to be injured in FY `18 there will be the initial hospitalization cost and on-going medical costs, inflated by 5.09 percent annually. Total cost $144,100 ($52,852 GR).

The fiscal note concluded that “there may be an increase in injuries or the severity of injuries to motorcyclists not wearing protective headgear which may indirectly result in increased costs to the state.” But there is no direct fiscal impact to state and local governments from the protective headgear exemption.



Currently 19 states, the District of Columbia, Guam, the Northern Marianas Islands, Puerto Rico and the U.S. Virgin Islands have universal helmet laws. Another 28 states require helmet use for certain groups, typically those under age 18 or under age 21. Each year, a handful of states introduce bills that would enact universal helmet laws, or conversely, to allow riders to legally ride un-helmeted. Many of those bills have fiscal notes attached to them. These important tools provide legislators an estimate of the impact a bill will have on state revenues and expenditures.  Fiscal notes vary dramatically however. Some fiscal notes in this report looked only at the impact on state revenue, while others aimed to articulate the more long term, comprehensive effect that a motorcycle helmet law would have on state budgets. 

Additional Information

Appendix A:  Summary of fiscal impacts these eight states considered in fiscal notes related to motorcycle helmet legislation.

  • Possible increased insurance premiums and additional Medicaid costs because of  the potential of lower helmet usage leading to more injuries.
  • The cost to state judicial departments to process anticipated increased violations after a universal helmet law took effect.
  • The cost to the licensing agency to change designations on driver’s licenses and to change informational highway signage to reflect new law.
  • The cost to the state to provide more motorcycle safety classes and to issue exemption stickers for those who qualified for a helmet exemption.
  • Revenue from increased citations if a universal helmet law was enacted.
  • Costs to law enforcement, county coroners and medical examiners if federal helmet standards were not required.
  • State revenue decreases because of a reduction in the number of citations issued if helmet law was repealed and possible state Medicaid expenditures because of an increase in head injuries to crash-involved motorcyclists not otherwise covered by insurance.
  • The costs to state agencies related to an increase in traumatic brain injuries from a universal helmet law repeal.

Appendix B:  Other potential considerations NHTSA suggests when developing fiscal notes related to motorcycle helmet legislation (if possible)

  • Potential reduction in motorcycle sales taxes and registrations from enacting a universal helmet law measured against the increase in savings from taxpayer-funded health costs from helmeted injuries.
  • Reduction in fines from helmet non-compliance (pre-paid and trial judgments).
  • Increase/decrease in revenue from motorcycle tourism after repeal /enactment of universal law.
  • What projections are being utilized regarding inpatient care for motorcyclists who sustain a brain injury?
  • If the bill requires riders to carry a minimum coverage for health insurance, does the minimum cover “likely” costs associated with un-helmeted-related injuries (i.e.. traumatic brain injury, extended hospital stays, quality of life expenditures, alternative transportation expenditures, etc.)?
  • Real-world costs of increased injuries and fatalities related to nonuse of a helmet (i.e.. loss of income, increase in EMS, etc.)?