Category guide
ACA & Health Benefits Requirements for Home Care Agencies, by State
Last reviewed: July 24, 2026
The federal employer mandate applies everywhere — 50+ full-time-equivalent agencies must offer affordable coverage or face 2026 penalties of $3,340/$5,010 per employee. What varies by state: the exchange your caregivers use, Medicaid expansion status, state 1095 filing duties, auto-IRA mandates, and paid family leave programs.
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Federal baseline (applies in every state)
Federal
ALE threshold & counting caregivers. The ACA employer mandate applies to Applicable Large Employers (ALEs) with 50+ full-time equivalent employees (30+ hrs/week or 130 hrs/month). Home care agencies with variable-hour caregivers can use the IRS look-back measurement method (3-12 month measurement period plus a stability period) to determine which caregivers must be treated as full-time and offered coverage.
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2026 employer mandate penalties. For 2026, the Section 4980H(a) penalty (no offer of minimum essential coverage to 95% of full-time staff) is $3,340 per full-time employee minus the first 30; the 4980H(b) penalty (coverage unaffordable or not minimum value) is $5,010 per full-time employee who gets subsidized exchange coverage (Rev. Proc. 2025-26).
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2026 affordability percentage. Coverage is affordable in 2026 if the employee's self-only contribution does not exceed 9.96% of household income (up from 9.02% in 2025), per Rev. Proc. 2025-25. Employers may use the W-2, rate-of-pay, or federal poverty line safe harbors in place of household income.
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2026 FPL safe harbor. A 2026 plan automatically satisfies the federal poverty line affordability safe harbor if the lowest-cost self-only contribution is no more than $129.89/month ($15,650 mainland FPL x 9.96% / 12). Alaska and Hawaii use higher FPL figures (about $162.26 and $149.31/month respectively).
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1095-C deadlines (2025 forms filed in 2026). ALEs must furnish Forms 1095-C to employees by March 2, 2026, or use the alternative method under the Paperwork Burden Reduction Act: post a clear website notice and furnish a copy within 30 days of request. E-filing of Forms 1094-C/1095-C with the IRS is due March 31, 2026, and e-filing is mandatory for employers filing 10 or more returns.
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ICHRA as a compliance option. An Individual Coverage HRA (ICHRA) lets agencies reimburse caregivers' individual-market premiums tax-free and counts as an offer of coverage under 4980H. An ICHRA is affordable if the employee's cost for the lowest-cost self-only silver plan, minus the HRA allowance, stays within the 9.96% affordability threshold; employee classes (e.g., field caregivers vs. office staff) can receive different allowances.
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Enhanced premium tax credits expired 12/31/2025. The ARPA/IRA enhanced premium tax credits expired December 31, 2025, restoring the 400% FPL subsidy cliff. KFF estimates average subsidized marketplace premium payments more than doubled (about +114%) for 2026, making employer-sponsored coverage and ICHRAs more attractive to caregivers - and increasing the chance that full-time employees seek subsidized exchange coverage that triggers 4980H penalties for non-offering agencies.
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Every state at a glance
| State | Exchange | Medicaid expansion | State 1095 filing | Auto-IRA mandate | Paid family leave |
|---|---|---|---|---|---|
| Alabama | HealthCare.gov | No | No | No | No |
| Alaska | HealthCare.gov | Yes | No | No | No |
| Arizona | HealthCare.gov | Yes | No | No | No |
| Arkansas | HealthCare.gov (SBE-FP) | Yes | No | No | No |
| California | Covered California | Yes | Yes | CalSavers (1+) | SDI + PFL |
| Colorado | Connect for Health Colorado | Yes | No | SecureSavings (5+) | FAMLI |
| Connecticut | Access Health CT | Yes | No | MyCTSavings (5+) | CT Paid Leave |
| Delaware | HealthCare.gov | Yes | No | EARNS (5+) | Paid Leave (2026) |
| District of Columbia | DC Health Link | Yes | Yes | No | UPL |
| Florida | HealthCare.gov | No | No | No | No |
| Georgia | Georgia Access | No | No | No | No |
| Hawaii | HealthCare.gov | Yes | No | Launching | TDI only |
| Idaho | Your Health Idaho | Yes | No | No | No |
| Illinois | Get Covered Illinois | Yes | No | Secure Choice (5+) | No |
| Indiana | HealthCare.gov | Yes | No | No | No |
| Iowa | HealthCare.gov | Yes | No | No | No |
| Kansas | HealthCare.gov | No | No | No | No |
| Kentucky | kynect | Yes | No | No | No |
| Louisiana | HealthCare.gov | Yes | No | No | No |
| Maine | CoverME.gov | Yes | No | MERIT (5+) | PFML (May 2026) |
| Maryland | Maryland Health Connection | Yes | No | MarylandSaves | Delayed (2027/28) |
| Massachusetts | MA Health Connector | Yes | Yes | No | PFML |
| Michigan | HealthCare.gov | Yes | No | No | No |
| Minnesota | MNsure | Yes | No | Secure Choice (phasing) | Paid Leave (2026) |
| Mississippi | HealthCare.gov | No | No | No | No |
| Missouri | HealthCare.gov | Yes | No | No | No |
| Montana | HealthCare.gov | Yes | No | No | No |
| Nebraska | HealthCare.gov | Yes | No | No | No |
| Nevada | Nevada Health Link | Yes | No | NEST (6+) | No |
| New Hampshire | HealthCare.gov | Yes | No | No | No (voluntary) |
| New Jersey | GetCoveredNJ | Yes | Yes | RetireReady (10+) | TDI + FLI |
| New Mexico | beWellnm | Yes | No | No (voluntary) | No |
| New York | NY State of Health | Yes | No | Secure Choice (10+, 2026) | DBL + PFL |
| North Carolina | HealthCare.gov | Yes | No | No | No |
| North Dakota | HealthCare.gov | Yes | No | No | No |
| Ohio | HealthCare.gov | Yes | No | No | No |
| Oklahoma | HealthCare.gov | Yes | No | No | No |
| Oregon | HealthCare.gov (SBE-FP) | Yes | No | OregonSaves (1+) | Paid Leave Oregon |
| Pennsylvania | Pennie | Yes | No | No | No |
| Rhode Island | HealthSource RI | Yes | Yes | RISavers (phasing) | TDI + TCI |
| South Carolina | HealthCare.gov | No | No | No | No |
| South Dakota | HealthCare.gov | Yes | No | No | No |
| Tennessee | HealthCare.gov | No | No | No | No |
| Texas | HealthCare.gov | No | No | No | No |
| Utah | HealthCare.gov | Yes | No | No | No |
| Vermont | Vermont Health Connect | Yes | Mandate, no reporting | VT Saves (5+) | No (voluntary) |
| Virginia | Virginia's Insurance Marketplace | Yes | No | RetirePath (expanding 2026) | No (voluntary) |
| Washington | WA Healthplanfinder | Yes | No | WA Saves (2027) | PFML |
| West Virginia | HealthCare.gov | Yes | No | No | No |
| Wisconsin | HealthCare.gov | No | No | No | No |
| Wyoming | HealthCare.gov | No | No | No | No |
Click any state for the full requirements with citations.