Quarterly Overview: State Laws & Health Plan Compliance
- The early months of 2025 have brought critically important developments in state benefits law, particularly concerning abortion and gender-affirming care, following a series of executive actions.
- These actions, while aimed at federal agencies, may influence state policies through agency guidance, court decisions, and conflicts with existing state laws.
- Other state law updates include changes to monthly penalties in California and Washington, D.C.
State Benefits Law Updates: Abortion, Gender-Affirming Care, and More
Table of Contents
- State Benefits Law Updates: Abortion, Gender-Affirming Care, and More
The early months of 2025 have brought critically important developments in state benefits law, particularly concerning abortion and gender-affirming care, following a series of executive actions.
These actions, while aimed at federal agencies, may influence state policies through agency guidance, court decisions, and conflicts with existing state laws. Ongoing litigation addresses these issues, with manny cases awaiting the outcome of a key gender-affirming care case before the U.S. Supreme Court. This article summarizes recent state news and benefit issues, including new rules for state programs.
Executive Summary
Abortion and Reproductive Health care:
- Executive orders have been issued regarding abortion and reproductive care, directing federal agencies to align with the new administrationS stance.
- Litigation increasingly focuses on the extraterritorial application of state laws, including challenges to Idaho and Tennessee abortion trafficking laws, out-of-state abortion referrals in Idaho, and indictments in Louisiana and Texas against a New York doctor for telehealth abortion services.
- wyoming laws prohibiting abortion and abortion medication have been overturned.
- Arizona and Missouri have blocked enforcement of state bans following voter amendments that protect abortion rights until viability.
- Idaho’s largest health system has filed a lawsuit seeking emergency abortion protections under the Emergency Medical Treatment & Labor Act (EMTALA).
- Several states have rolled back abortion reporting requirements.
Gender-Affirming Care Issues:
- Executive orders have been signed on gender-affirming care and transgender services, directing federal agencies to act in accordance with the new administration’s position.
- Lawsuits from private plaintiffs and states challenge these orders, with some courts issuing restraining orders on the freezing of federal funding.
- Multiple state attorneys general have directed the continuation of gender-affirming care under state nondiscrimination laws and coverage mandates.
- The U.S. Supreme Court’s ruling in the Skrmetti case is pending; the administration has stated it no longer considers the underlying state laws unconstitutional.
- Kansas has passed its first gender-affirming care law, banning puberty blockers, hormone therapy, and surgeries for minors transitioning from their assigned gender at birth.
- Litigation is stayed in many states pending the Skrmetti ruling, but some states have moved forward.
- A federal appeals court in Indiana has upheld its gender-affirming care ban pending further litigation.
- A Missouri circuit court has upheld its state ban.
- The Montana Supreme Court has blocked its state ban from enforcement during ongoing litigation.
- Oregon has issued rules related to a previous coverage mandate for medically necessary gender-affirming treatments.
- California’s Transgender, Gender-Diverse and Intersex (TGI) act requires compliance with provider directory updates and cultural competency training rules by March 2025.
Other state law updates include changes to monthly penalties in California and Washington, D.C. for individuals without minimum essential coverage, and new rules for out-of-state participants in the Washington Cares Fund long-term care insurance program.
ABORTION AND REPRODUCTIVE CARE
Executive Orders Relating to Abortion and Reproductive Care
The Trump Administration issued several executive orders in early 2025 related to abortion and reproductive care services. One order, Enforcing the Hyde Amendment (Jan. 24, 2025), revokes previous orders that supported access to abortion care. This order aims to enforce the Hyde Amendment, which prohibits federal funds for abortion services. Another order, Memorandum for the Secretary of State, the Secretary of Defence, the Secretary of Health and Human Services, the Administrator of the United States for International Development/The Mexico City Policy (Jan. 24,2025) reinstates the Mexico City Policy,also known as the Global Gag Rule,which restricts U.S. funding to international NGOs involved in abortion care.
out-of-State Abortion Care a Hot Litigation Topic
State Abortion Trafficking Laws Challenged in Court
Idaho banned abortion trafficking in 2023, prohibiting the recruitment, harboring, or transportation of a minor for an abortion without parental consent. A federal appeals court ruled that Idaho can enforce most of its law while litigation continues, but blocked the part of the law that prohibits “recruiting” a minor to get an abortion.
In 2024, Tennessee implemented a similar law. In September 2024, a federal judge blocked the law from being enforced while the case continues, ruling that the state cannot “make it a crime to communicate freely” about legal abortion options.
Idaho Court Rules on Out-of-State Abortion Referrals
In December 2024, the same federal appeals court ruled that Idaho’s attorney general could not use a state law prohibiting “assisting an abortion” to prosecute providers for referring patients for out-of-state abortions. The court held that such restrictions would violate medical professionals’ rights to free speech. The decision allows doctors in Idaho to advise patients seeking out-of-state care while litigation continues.
New York Provider Faces Out-of-State Criminal and Civil Charges for Telehealth Abortion Prescriptions
A New York doctor was indicted on charges of criminal abortion in Louisiana in late January for prescribing an abortion pill to a teenage patient through a telehealth visit. The same New York provider faces civil charges brought by the Texas attorney general,alleging that she prescribed and provided abortion medication to a Texas patient via telemedicine.In February 2025, New York’s governor announced that she rejected a request from Louisiana to extradite the doctor to the state for prosecution.
Other Updates to State Abortion laws
Wyoming Strikes Down State Ban
Two Wyoming laws, one prohibiting abortion and the other prohibiting pill-induced abortions, were under preliminary injunction as of March 2023. A district court ruled on both laws in November 2024, holding that the prohibitions were unconstitutional and permanently blocked both from enforcement. An appeal has been filed, but the ruling allows abortions to be performed up to viability while the appeal continues.
Initial Steps Taken to Resolve Ballot Amendments in Conflict with state Laws
Arizona providers have filed a lawsuit challenging the state’s existing 15-week ban after state voters approved a constitutional amendment in November enshrining the right to abortion until viability. The state Attorney General pledged to not enforce the state’s current 15-week ban while litigation continues.
A Missouri court in December similarly blocked enforcement of the state’s current total ban while the underlying lawsuit challenging the ban continues in court. Voters in Missouri also enshrined the right to abortion until viability in the state constitution last November.
EMTALA drama Continues in Idaho
In the ongoing saga of litigation over EMTALA and state abortion laws, Idaho’s largest health system has now sued the state attorney general seeking emergency abortion protections. The suit, filed by St. Luke’s Health System, LTD. in January 2025, requests a declaratory judgment from a federal court that Idaho’s near-total abortion ban is partly preempted by the federal EMTALA law and seeks a permanent injunction. Idaho’s abortion ban is temporarily blocked to the extent it conflicts with EMTALA after a series of court decisions last year, including a U.S. Supreme Court ruling, stemming from a Biden Administration lawsuit. Citing concerns that the new administration would seek to vacate the injunction and dismiss the complaint entirely, St. Luke’s filed its own suit to avoid leaving the status of abortions as emergency stabilizing care once again in a gray area of legality. The biden Administration’s federal suit was officially dropped in early March, as expected. Simultaneously occurring, the St.Luke’s suit has moved forward and secured a temporary inunction against the state’s abortion ban, preserving access to emergency abortions under EMTALA regulations for now while the case continues.
GENDER-AFFIRMING CARE
Executive Orders Relating to Gender-Affirming Care
Similar to the executive orders on abortion, the Trump Administration issued new executive orders in early 2025 relating to gender-affirming care and transgender services. these orders direct federal agencies to take actions consistent with the administration’s position, perhaps impacting access to care and federal funding.
State Responses to Federal Actions
In response to the executive orders, private plaintiffs and states have filed lawsuits challenging their legality. Some courts have issued restraining orders on the executive order freezing federal funding,indicating early legal pushback against the administration’s directives.
Over a dozen state attorneys general have issued directives to continue providing gender-affirming care in accordance with state nondiscrimination laws and coverage mandates, highlighting a divergence between federal and state policies on this issue.
Skrmetti Case and Supreme Court Implications
The U.S.Supreme Court’s ruling in the high-profile Skrmetti case remains pending, creating uncertainty about the future of gender-affirming care laws. The administration has communicated to the court that it no longer considers the state laws underlying the lawsuit unconstitutional, a shift from the previous administration’s stance.
State Legislative and Legal Developments
Kansas passed its first gender-affirming care law, banning puberty blockers, hormone therapy, and surgeries for minors seeking to transition from their gender assigned at birth. This law reflects a growing trend among some states to restrict access to gender-affirming care for minors.
Litigation is stayed in many states while awaiting the Skrmetti ruling, but some states have seen movement: a federal appeals court in Indiana kept its gender-affirming care ban in effect pending further litigation; a Missouri circuit court upheld its state ban in a lawsuit brought by transgender children and their parents; the Montana Supreme court blocked its state ban from enforcement while litigation continues in a lower court; and Oregon issued rulemaking related to a previous coverage mandate requiring medically necessary gender-affirming treatments.
California’s TGI Act
California’s Transgender, Gender-diverse and Intersex (TGI) Act requires compliance with provider directory updates and cultural competency training rules by March 2025. This act aims to improve access to care and ensure respectful treatment for transgender, gender-diverse, and intersex individuals.
OTHER STATE LAW UPDATES
Individual Health Insurance mandates
california and Washington, D.C. have released their flat-dollar amount monthly penalties for individuals failing to maintain minimum essential coverage (MEC) as defined under the ACA for calendar year (CY) 2024. In California, the penalties are $900 per adult and $450 per child. In Washington, D.C., the penalties are $795 per adult and $397.40 per child, or up to $2,385 per family.
WA cares Fund
Washington has implemented new rules related to the WA Cares Fund.On feb. 14, 2025, Washington filed CR-103 and adopted rules to implement a portion of Substitute HB 2467, which allows individuals who relocate outside the state to continue participating in the WA Cares Fund. these rules define “out-of-state participant” and align the WA Cares and Paid Family and Medical Leave appeals processes. These rules will be effective March 17,2025.
Okay, I will analyze the provided text to identify missing facts and then conduct internet searches to try and fill in the gaps.
Analysis of Missing Information and Questions Arising:
based on the provided article, here’s what’s missing or generates questions needing further research:
- Idaho’s Continuing Saga Regarding EMTALA: The article references litigation regarding EMTALA and Idaho’s abortion ban. More detail about the specifics of the case, rulings, related legal arguments, and the health system’s lawsuit would be helpful to clarify.
Here’s a breakdown of the missing contexts:
Impact of the Idaho’s near-total abortion ban on EMTALA.
Specifics of St. Luke’s Health System’s lawsuit filing against the state in Idaho.
Outcome of the related U.S. Supreme Court Ruling.
Details about the Biden Governance’s lawsuit and its conclusion: Why and how was it dropped?
The state’s attorney generals position.
Now, the Internet Search/Research Process:
I will use the following search terms (and variations) on reputable search engines (if needed):
“Idaho EMTALA abortion ban”
“St.Luke’s Health System Idaho abortion lawsuit”
“Idaho Supreme court ruling on EMTALA and abortion Ban”
“Biden administration EMTALA lawsuit Idaho abortion”
“Idaho attorney general EMTALA abortion”
Since the article frequently cites dates in the context of 2025, I will focus my search on the time 2023-present, to yield the most relevant and current information on Google and othre search engines.
Disclaimer: As an AI, I cannot directly access the internet, so this will be a simulation of the search process. Based on common search results, here’s what the missing information would likely include:
1. Idaho’s Continuing Saga Regarding EMTALA:
Key Search Terms: “Idaho EMTALA abortion ban” , “St. Luke’s Health System Idaho abortion lawsuit”
Likely findings:
EMTALA and Abortion in Idaho: The crux of the issue is that EMTALA requires hospitals to provide stabilizing care in emergency situations, which could include abortion if the woman’s life is at risk. Idaho, with its restrictive abortion laws, clashes with this federal mandate.
st. Luke’s Lawsuit: st. Luke’s likely sued in 2025 to seek clarity that Idaho’s abortion ban doesn’t supersede the EMTALA’s requirement.This likely seeks explicit court backing to provide abortions as emergency care, despite Idaho’s abortion ban.
Specific Arguments of St. Luke’s: St. Luke’s likely argued that the state’s ban puts them in an unfeasible position: potentially violating federal law (EMTALA) if they don’t provide an abortion in a life-threatening situation and potentially violating state law if they do.
The Supreme Court Ruling: Regarding the U.S. Supreme Court, a previous Court ruling, or the lack thereof, would be cited on the prior litigation. The ruling is probably mentioned in cases relating to EMTALA and/or state abortion bans.
Biden Administration’s Lawsuit and the State’s Response; The Biden administration likely filed a suit to fight Idaho’s abortion ban and to support the federal guidance. This indicates federal support for emergency abortions under EMTALA within the state of Idaho. This supports access to emergency abortions under EMTALA regulations for now while the case continues.
Idaho Attorney General’s Position The attorney general may have argued that Idaho’s state law does not conflict with EMTALA.
The Federal Court’s Ruling: The outcomes of federal court rulings are critically important to the status of abortion cases.
Exmaple search result (simulated):
“A federal district court has issued a temporary injunction in St. Luke’s suit in March 2025, finding that the state’s abortion ban is preempted by EMTALA when a pregnant patient’s life is at risk. This means the health system, for the time being, can perform necessary abortions to stabilize patients without fear of legal repercussions. However,the legal battle continues as Idaho’s attorney general has vowed to appeal,arguing that the state’s interests in protecting fetal life outweigh EMTALA’s requirements.*”
By using the above sources, I would have a better picture to synthesize the information.