H.R. 5390 — FAMILY Act

This section defines terms used in the Act, including "(1) caregiving hour," as a 1-hour period of qualified caregiving limited to 12 times an individual's regular workweek hours (i.e., hours regularly worked the month before the benefit period begins) per benefit period; "(2) eligible individual," as an individual entitled to a monthly benefit under section 4 upon application; "(3) Commissioner," as the Commissioner of Social Security; and "(4) Deputy Commissioner," as the head of the Office of Paid Family and Medical Leave. It further defines "(5) qualified caregiving," as any activity other than regular employment (a) for reasons specified in FMLA section 102(a)(1)(A), (B), or (E) (29 U.S.C. 2612(a)(1)(A), (B), or (E)); (b) to care for a qualified family member with a serious health condition (using the FMLA definition); (c) due to the individual's own serious health condition; or (d) because the individual or a qualified family member is a victim of a qualifying act of violence (e.g., seeking counseling, medical care, legal assistance, relocation, or school enrollment); and "(6) qualified family member," encompassing a spouse (including domestic partner), child (regardless of age), parent, sibling, grandparent, grandchild, or equivalent family relationship (expanding beyond FMLA family members). Additional definitions cover "national average wage index" (as under Social Security Act section 209(k)(1)), "child," and "domestic partner" (i.e., committed relationship between two individuals aged 18 or older).

This section establishes within the Social Security Administration the Office of Paid Family and Medical Leave, headed by a Deputy Commissioner appointed by the Commissioner. The Deputy Commissioner is responsible for (1) hiring personnel; (2) issuing regulations; (3) entering cooperative agreements; (4) determining eligibility and benefit amounts and making timely payments under the paid family and medical leave insurance benefits program; (5) maintaining records and preventing fraud; (6) providing information on eligibility, claims, benefits, and related rights; (7) annually notifying employers and issuing public reports on benefit utilization by demographics; and (8) conducting culturally competent outreach to increase utilization. This section further requires the Commissioner to provide necessary SSA data to the Deputy Commissioner; directs good-faith data-sharing efforts with other federal agencies; and requires a report to Congress within 12 months of enactment on relevant federal databases (including needed congressional action for access) and the feasibility of expediting benefit application reviews and payments.

This section establishes the Family and Medical Leave Insurance benefit program administered by the Commissioner, providing prorated monthly payments to eligible individuals engaged in qualified caregiving. Eligibility requires (1) filing an application; (2) caregiving (or anticipated caregiving) during the 120-day period centered on the filing date; (3) wages or self-employment income during the base period beginning with the most recent calendar quarter ending at least four months before the benefit period and ending the prior month; and (4) at least $2,000 (indexed annually to the national average wage index beginning in 2027) in such income during the most recent complete eight-calendar-quarter period ending at least four months before the benefit period. The monthly benefit equals the greater of the minimum benefit amount ($580, indexed annually) or the lesser of the maximum benefit amount ($4,000, indexed annually) or the individual's tiered monthly benefit rate—85% of average monthly earnings up to $1,257 (indexed annually), plus 69% of such earnings above $1,257 up to $3,500 (indexed), plus 50% above $3,500 up to $6,200 (indexed)—prorated by caregiving hours divided by regular workweek hours times workweeks in the month (zero if under four caregiving hours). Average monthly earnings equal one-twelfth of wages and self-employment income from the highest of the prior three calendar years. Benefits are reduced by certain other benefits received, as specified by regulation. (Thus, the program supplements unpaid job-protected leave under the Family and Medical Leave Act by providing wage replacement for caregiving.)

This section establishes a grant program under which, beginning in calendar year 2027, the Commissioner makes annual payments to each "legacy state" (i.e., a state that enacted a paid family and medical leave law by the date of enactment, certifies intent to continue as a legacy state with required data sharing through the first calendar year at least three years after enactment, and thereafter maintains a program providing at least 12 full workweeks of comprehensive paid leave benefits during each 12-month period—at a wage replacement rate equivalent to that under the federal program in section 4—to individuals eligible under federal rules) that met data sharing requirements in the prior year. Grant amounts equal the lesser of (1) the estimated total comprehensive paid leave benefits that would have been paid under section 4 (plus Commissioner administration costs not exceeding 7% of benefits) to individuals who received state benefits in the prior year if the state had not been a legacy state, or (2) the prior year's total state costs for such benefits—including employer-provided benefits (directly, via insurer, or multiemployer plan) and state administration costs not exceeding 7% of benefits. (Thus, grants effectively reimburse legacy states for maintaining equivalent programs in lieu of the federal program.) The Commissioner may make estimated advance payments during a year, treat employer-provided benefits as state benefits for all Act purposes, distribute grant shares to employers, and require states to share detailed beneficiary data (e.g., names, identity information, payment dates and amounts). The section also defines "covered employment under the law of a legacy state" as employment (or self-employment) eligible for benefits under the state law during the legacy period.

This section directs the Commissioner, in consultation with the Secretary of Labor, to prescribe regulations necessary to implement the Act, considering input from state paid family and medical leave insurance programs. In developing such regulations, the Commissioner must solicit input from a volunteer advisory body of not more than 15 individuals, including experts in relevant subject matter and state program officials, appointed as follows: (1) five by the President; (2) three by the Senate majority leader; (3) two by the Senate minority leader; (4) three by the Speaker of the House of Representatives; and (5) two by the House minority leader.

This section directs the Comptroller General of the United States to submit to Congress, as soon as practicable after calendar year 2026 and every five years thereafter, a report analyzing family and medical leave insurance benefits paid under section 4 during the covered period (i.e., calendar year 2026 for the initial report; the five-calendar-year period ending December 31 of the prior year for subsequent reports). The report must identify (1) total applications for such benefits and average days from receipt to initial eligibility determination; (2) total requests for review of initial adverse eligibility determinations and average days from request to final determination; (3) total monthly benefit claim reports and average days from receipt to initial determination; (4) total requests for review of initial adverse claim report determinations and average days from request to final determination; (5) any excessive delays in those periods, including causes or correlations to claimant demographics, industry sector, or qualifying reason; and (6) any additional data needed for the application process to produce the report.