Largely in response to Congress reducing the federal ACA individual mandate penalty to $0 (effective beginning 2019), several states passed their own individual mandates. Specifically, California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont require their residents to maintain minimum essential healthcare coverage or pay a tax penalty. States that impose individual mandate penalties on taxpayers reserve the right to determine penalty amounts at their discretion. Penalties for employer non-compliance with the filing and distribution requirements are discussed in the statespecific sections below.
Beginning in 2025, changes to federal ACA reporting requirements permit employers and health insurance carriers to furnish Forms 1095-B and 1095-C to employees upon request (with adequate notice of the opportunity to request the applicable form) instead of automatically distributing these coverage statements. However, each state’s individual mandate still generally requires employers to automatically distribute coverage statements to employees (regardless of any request) and to submit reports to state agencies by specific annual deadlines. Importantly, the state reporting requirements are generally based on an employee’s home address for any portion of the reporting year, regardless of the location of the employer’s headquarters or the situs state of the healthcare contract.
To help employers maintain compliance with applicable state reporting requirements, this publication provides a summary of the reporting requirements under each state’s individual mandate.
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