## Facts

- New York enacted the Women’s Health and Wellness Act requiring employer health plans with prescription drug coverage to include coverage for prescription contraceptives.
- The statute contained a narrow exemption for “religious employers,” limited to nonprofits whose primary purpose is inculcating religious values and that primarily employ and serve co-religionists.
- Religious-affiliated nonprofit social service organizations (including Catholic Charities agencies) provided services to the general public and employed individuals of many faiths.
- Plaintiffs offered employee health insurance with prescription coverage and objected on religious grounds to funding contraception coverage.
- Plaintiffs did not qualify for the statutory exemption and could avoid the mandate only by dropping prescription drug coverage entirely or changing operations to meet the exemption’s criteria.
- Plaintiffs sued the state insurance superintendent, alleging that the mandate and exemption violated federal and New York constitutional protections for religious exercise and related constitutional guarantees.
- Lower courts granted summary judgment to the state and dismissed the complaint.

## Issues

1. Whether the contraceptive-coverage requirement, as applied to religiously affiliated social service organizations, violates the Free Exercise Clause of the First Amendment or the free-exercise provision of the New York Constitution.
2. Whether the narrow “religious employer” exemption violates the Establishment Clause or state constitutional religion protections by creating impermissible religious classifications or entanglement.
3. Whether the statute violates equal protection, due process, or related constitutional constraints.

## Decision

- The Court of Appeals of New York affirmed the dismissal and upheld the mandate and exemption.
- The court held the mandate is a neutral law of general applicability that incidentally burdens religious practice and therefore does not trigger heightened scrutiny under federal free-exercise doctrine.
- The court declined to interpret the New York Constitution as providing broader free-exercise protection in this context.
- The court held the exemption did not create unconstitutional denominational preference or excessive entanglement and did not render the scheme non-neutral.
- The court rejected plaintiffs’ remaining constitutional claims.

## Legal Principles

- Under federal free-exercise doctrine, a neutral and generally applicable law that incidentally burdens religious exercise is ordinarily reviewed under a deferential standard rather than strict scrutiny.
- A state court may interpret state free-exercise protections in parallel with federal doctrine absent a persuasive reason to apply a different test.
- A narrow religious exemption drawn with neutral criteria and not favoring particular denominations is not inherently invalid under establishment principles.
- Public health and equality objectives can provide a rational basis for generally applicable insurance regulation, even when compliance conflicts with sincere religious objections.

## Conclusion

New York’s highest court sustained a statutory requirement that employer plans with prescription coverage include contraceptive coverage, concluding that the law was neutral and generally applicable and that the limited exemption for certain religious employers did not violate federal or state constitutional religion protections.


Catholic Charities of the Diocese of Albany v. Serio, 859 N.E.2d 459 (N.Y. 2006)