UC San Diego

The objective of this paper was to analyze trends in state mandated benefit laws after the ACA intended to reduce the growing rate. One provision of the ACA was intended to discourage states from enacting new mandated benefit laws by establishing a list of Essential Health Benefits (EHBs). A comparative analysis of state mandated benefit laws from years 1949-2022 was conducted. Data was collected through 1. BlueCross BlueShield (BCBS) 2. CMS database of state mandates, 3. Searches of legiscan and google, and 4. California Health Benefit Review Program (CHBRP). Dates were collected and compared for each individual mandated law. Additionally, categories of state mandated laws specific to fertility preservation were examined. Data from 2011-2019 indicated that there was a decrease in enacted/revised mandated benefit laws after the ACA. State legislative bill text for mandates specific to fertility preservation was analyzed to determine what type of language is being used to ensure states are not responsible for defraying the cost of mandated benefit laws. The main findings from this study highlights that there are still benefit mandate laws that are being enacted post the ACA that could fall outside of EHBs. This study highlights that there are gaps with what constitutes benefit mandate laws falling under EHBs or needing state defrayal. Additionally, more clarification is needed on what the current process is of determining which benefit mandate laws requires state defrayal.