How do California's menopause policies compare to federal protections and other states as of 2025?
Executive summary
California in 2025 sits at the center of a national menopause-policy push: lawmakers passed the bipartisan Menopause Care Equity Act (AB 432) but Governor Gavin Newsom vetoed similar measures twice, and the 2025 AB 432 would have required insurer coverage for many menopause treatments and mandated clinician education while applying to roughly 22.2 million enrollees (58.8% of Californians) according to CHBRP [1] [2]. Federally, Congress has considered broader research and program bills like the Advancing Menopause Care and Mid‑Life Women’s Health Act/S.4246 and other measures but no sweeping federal mandate exists as of 2025 [3] [4].
1. California’s current legislative posture: ambitious bills, mixed outcomes
California legislators centralized menopause in 2025 with AB 432, which would have required health plans to cover menopause and perimenopause treatments, deliver annual clinical guidance to primary‑care providers, and grant continuing‑education credit for menopause coursework, applying to millions of enrollees [5] [6] [2]. That bill cleared key legislative steps and drew support from advocates and some press coverage as a model for affordability and provider training [7] [8]. Yet the governor vetoed a similar prior bill—calling it “too far‑reaching”—and high‑profile criticism followed when the legislature’s 2024–25 efforts stalled at the executive level [9] [1] [10].
2. What AB 432 would actually do — and where it stops
Text and analyses show AB 432 would: mandate insurers to provide coverage for evaluation and treatment options for perimenopause and menopause symptoms (including hormone therapies and osteoporosis prevention in sponsors’ descriptions), require plans to supply clinical care recommendations annually to contracted primary‑care providers, and create continuing‑education incentives for clinicians through credit multipliers [5] [11] [6]. The CHBRP analysis estimated the law’s reach across commercial, CalPERS and Medi‑Cal enrollees, but the bill also raised concerns about criminal penalties for willful insurer violations and about scope of covered treatments—issues that drew the governor’s pushback [2] [5] [9].
3. Federal activity: research, reports and incremental steps, not mandates
At the federal level, Congress has considered more programmatic responses: the Advancing Menopause Care and Mid‑Life Women’s Health Act (S.4246) and related bills would fund research, provider training, and public‑health coordination and authorize tens to hundreds of millions over multiple years—but do not currently impose nationwide insurance mandates or workplace rules [3] [12] [4]. Separate federal initiatives — such as proposed VA studies and bills targeting veterans’ menopause care — reflect policy attention but stop short of imposing coverage requirements on private insurers [13].
4. How other states compare: a patchwork of approaches
By mid‑2025, states formed a varied landscape. Some states already mandated insurer coverage (e.g., Louisiana and Illinois in prior years), others limited actions to provider education or awareness weeks, and Rhode Island moved into workplace accommodation territory by requiring employers to provide reasonable accommodations for menopause‑related conditions in 2025 [14] [15] [16]. Reporting and trackers put more than a dozen states considering bills—over 20 bills in 13–15 states—covering coverage mandates, clinician training, workplace protections, or public‑education efforts [17] [18] [19].
5. Competing perspectives and political fault lines
Supporters argue mandates close affordability and knowledge gaps that force people to forgo hormone therapy or osteoporosis prevention and that clinician training reduces dismissal of symptoms [11] [20]. Critics—including medical associations—worry about condition‑specific continuing medical‑education mandates and about requiring coverage for expensive or non‑FDA‑approved treatments; Governor Newsom framed prior bills as “too far‑reaching” in scope [7] [9]. Independent fiscal reviews like CHBRP suggested limited premium impact in some analyses, but the governor and other opponents cited broader health‑policy and cost concerns [2] [1].
6. Practical consequences for Californians today
Because AB 432 and companion measures did not become an enforceable, signed law as of the latest reporting, Californians still face a mix of insurer practices and limited statutory protections: provider‑education requirements from earlier state action exist, but comprehensive insurer mandates and the CME mandates proposed in 2025 remain contested [15] [5]. Advocates point to private‑sector momentum and state experiments—Rhode Island’s workplace rule and other states’ insurance laws—as evidence of alternatives California could follow or refine [16] [14].
Limitations: available sources do not mention implementation details after a gubernatorial signature for AB 432; my summary is limited to the reporting and legislative texts provided above [5] [2].