An Employer's State-by-State Guide to Paid Sick Leave in the US

Employee illness is an inevitable reality of every workplace. For employers, employee medical leave—especially longer-term time off for surgeries, chronic illness, and major health complications—can be challenging to manage from an administrative, legal, and operational perspective. Staying informed about your obligations and responsibilities is essential for navigating sick leave policies and effectively supporting your team.

In the US, paid sick leave is not a mandatory requirement at the federal level. Instead, as of 2025, 18 states and Washington, D.C. have their own paid sick leave laws, with the remaining states leaving this benefit to the employer's discretion. Therefore, for employers managing distributed teams, understanding jurisdiction-specific legislation becomes particularly important.

Deel's suite of US-focused products, such as Deel PEO and US Payroll, are purpose-built for simplifying HR, compliance, and payroll processes for multistate and international companies. With our PEO service, you can outsource admin-heavy operations, including benefits, sick leave, and other worker entitlements.

In this article, we cover essential information for employers and HR teams to navigate paid sick leave rules across the different US states.

How does sick leave work in the US?

There are several important aspects of sick leave to consider when operating a business in the US.

What counts as paid sick leave?

Paid sick leave is a job benefit that allows employees who are unwell to take time off, while still receiving full or partial compensation. In most cases, the specific paid sick leave policies are at the employer’s discretion (unless state laws are in place). Some of the circumstances typically covered by paid sick leave include:

• Illness: Any physical or mental condition (a cold, the flu, nausea, migraine, etc.) preventing the employee from fulfilling their job duties safely or effectively
• Injury: Any physical hurt or damage that interferes with the ability to perform work
• Medical appointments: Necessary visits to the doctor, from routine check-ups to specialist visits or follow-up care
• Recovery from a medical procedure: Time off to recuperate after undergoing a medical intervention such as surgery
• Caring for sick family members: Under certain policies, paid sick leave might also be used to look after an ill child or spouse

Learn more about the different types of employment perks with our article on statutory and voluntary benefits.

What is unpaid sick leave?

Unpaid sick leave is job-protected time off work due to illness, which the employee can take without receiving any compensation. In certain cases, the company might offer this option when an employee has reached their maximum allowance of paid sick leave.

Not all employers offer unpaid sick leave. Instead, workers might have to use their vacation days or negotiate with their employer.

What paid sick leave regulations does the federal government mandate?

The federal government does not mandate paid sick leave, except in extraordinary circumstances such as the COVID-19 pandemic, when up to two weeks were granted for COVID patients nationwide. However, some protections do exist, such as the Family and Medical Leave Act (FMLA).

FMLA entitles eligible employees to 12 weeks of job-protected, unpaid leave of absence for serious health conditions, birth or adoption of a child, caring for a sick relative, or certain military family needs. FMLA-qualified leave is not the same as paid sick leave, as it does not apply to minor illnesses but instead provides protection for employees experiencing extraordinary health or family challenges.

The governmental website provides more information on FMLA coverage, qualifying conditions, and procedures, as well as an employer-specific guide to FMLA.

How do employees accumulate paid sick leave?

There are two ways in which employees commonly earn paid sick leave and other personal time off.

Accrual

Employees earn (or ‘accrue’) paid sick leave at a specific rate, typically an hour for every 30 hours worked. However, this can vary based on different employers and local legislation.

Usually, a worker begins accruing paid sick leave from their first day of work, though certain employers may first require a ‘waiting period’ before allowing new employees to use any leave benefits (for example, 90 days). Many employers also permit their employees to carry over their earned sick leave to the next year (if unused), up to a set limit.

Employers may choose accrual paid leave as a way to mitigate excessive costs of employees taking time off. Accrual encourages employees to limit their sick leave usage where possible and be thoughtful when requesting it. However, accrual policies can also result in presenteeism, where workers show up at work while unwell, potentially making others sick and affecting productivity.

Frontloading

In this variation, employers award employees their full allotted paid sick leave at the beginning of the year. For new hires who join partway through the year, this allowance might be adjusted to reflect a smaller leave entitlement.

For employers, frontloading simplifies planning and helps reduce the administrative burden of monitoring and tracking accrual rates. It's also beneficial for job satisfaction and can improve competitiveness in the talent market, with new hires accessing their days off immediately instead of waiting until they have earned them.

One risk is if new employees take all their time off and leave the company. This is typically mitigated by adopting repayment policies that require unearned time off to be repaid if someone quits.

What is an employer size threshold?

In the US, an employer size threshold is the minimum number of employees above which employers are subject to paid sick leave laws. These thresholds differ between different jurisdictions, with certain states requiring all employers to offer sick leave, while others exempt small businesses.

HR teams need to be aware of the specific mandates that apply in different places and monitor if certain employer size thresholds are crossed. Failure to comply with regulations could incur financial and legal penalties.

See also: Global Sick Leave and Mental Health Day Policy Template

What is the difference between sick leave and personal time off (PTO)?

There are several differences between sick leave and PTO. A summary of the key distinctions is provided in the table below:

Paid sick leave laws by state

Some states have their own legislature with regard to paid and unpaid leave. For instance, states like California and Colorado do not exempt smaller businesses from paid sick leave laws, while others impose specific accrual rates (Nevada, Vermont), or cap how much paid sick leave can be offered (Alaska, Rhode Island).

A state-by-state breakdown of the key paid sick leave legislation differences is provided in the table below:

Consolidate your sick leave compliance and admin with Deel

Paid sick leave can be an important component of a competitive benefits package. The US federal government does not mandate paid sick leave, but different states and cities can have their own rules on the number of days, accrual rates, and employer size thresholds. Moreover, these rules can change year on year, meaning HR teams need to stay on top of legislative changes at all times.

For employers who manage distributed teams, selecting the right solution to navigate rules across state lines is imperative.

With Deel PEO, you can outsource your benefits admin and compliance, enabling you to free up essential resources and focus on success while our team handles your HR operations. Our PEO service absorbs many of the liabilities faced by companies through a co-employment model. This includes risk management, human resource management, payroll taxes, and employee tax compliance, as well as offering the following services:

• Expert tax and benefits compliance with a fully in-house team and infrastructure
• Payroll management and administration
• Exclusive access to Aetna International plans for US W-2 employees living abroad
• Unlocking competitive benefit plans from leading providers
• Comprehensive HRIS with IT, Finance, and PTO management
• State-specific trainings, HR policies, and on-demand HR support

Find out more by booking a demo with us.