In December 2017 (effective January 1, 2019), Congress repealed the financial penalties for individuals not having health insurance, but the requirement to  have health insurance is still in place. Since then, some states have turned to state individual mandates in order to keep their healthcare marketplaces stable and generate additional revenue. 

Which states have individual healthcare mandates?

Currently, Massachusetts, California, the District of Columbia, New Jersey, Rhode Island, and Vermont have passed state individual mandates.

With each state passing its own individual mandate, it makes it difficult for companies to keep up with all the different regulations and reporting requirements. Essentially, even if you have one employee filing taxes in one of these states, your company must comply with that state’s individual mandate. This means companies will not only have to be ACA complaint at the federal level, but also at the individual state levels.

BenefitScape has obtained all of the various credentials and testing to be able to send your Federal XML file to those states currently requiring filing for TaxYear 2019.  We would be pleased to work with you to accomplish the eFiling to New Jersey and the District of Columbia. 

The information below details necessary reporting Updated as of October 2019     

Massachusetts  At the end of each coverage year, employers that provide minimum creditable coverage  (MCC) or their vendors must distribute Form MA 1099-HC to covered Massachusetts residents  and report this information to the state Department of Revenue (DOR) by January 31.Most employers rely on their insurance vendors or Third-Party Administrators to determine MCC status, distribute the forms and file the DOR report.   More details …

New Jersey  Beginning in 2020, New Jersey will require employers to report prior-year health coverage information for covered employees and their dependents residing in the state. Reporting guidance specifies that employers and other MEC providers must transmit health  coverage returns for the 2019 tax year through New Jersey’s e-file system for W-2 forms by  March 31.The returns must contain the information required for IRS Forms 1094-C and 1095- C. Companies are encouraged to send only New Jersey residents’ data, but the state will accept the same 1094/1095 files sent to the IRS — even if they include data for out-of-state residents.  More details …

Washington, DC  The reporting requirement for DC encompasses any employee for whom the employer withholds DC taxes, or any employee who has a DC mailing address, even if the employer doesn’t withhold and report DC taxes. Employers that furnish covered employees with MEC notices for federal purposes don’t have to provide duplicate notices for DC.  More details …

California  Beginning Jan. 1, 2020, California’s new mandate (2019 Ch. 38, SB 78) will require state residents to maintain Minimum Essential Coverage (MEC) for themselves and their dependents.  Self-insured plan sponsors, health insurers and other entities that provide MEC to residents  must file coverage reports with the California Franchise Tax Board (FTB) by March 31 after the 
coverage year has ended. The FTB will develop reporting forms, but currently, the same  information reported to IRS under IRC § 6055  will suffice for California reporting.   More details …

Rhode Island  Rhode Island’s Market Stability and Reinsurance Act (2019 Ch. 88, HB 5151 Art. 11) reinstates the individual coverage mandate for state residents, beginning in 2020. The state law closely  follows the ACA mandate in its original form, including the definition of MEC and penalty  calculations.While it has not been confirmed, the IRS coverage-reporting forms may suffice for  Rhode Island’s reports.  More details …

Vermont  Amendments to Vermont’s individual health coverage mandate (2019 Act 63, HB 524) require  residents to self-report compliance beginning in 2020. Residents filing individual income tax returns will indicate if they had MEC during the tax year and, if requested by the state, will have to submit their IRS Forms 1095-B and 1095-C as proof. Vermont doesn’t require employer  reporting unless the ACA mandate (IRC § 6055) for MEC providers to furnish a statement to covered individuals is suspended or eliminated.   More details …