FMLA and Family Leave Laws for Dental Practices

The Family and Medical Leave Act applies to private employers that employ 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.

Two details hide in that sentence.

The headcount has to hold on each working day across 20 or more workweeks — a short stretch above 50 during a busy hiring season does not get you there.

And the test looks at this year or last, so a practice that held 50 or more employees across 20 or more workweeks in the prior year is a covered employer in the current one even if the team has since shrunk.

If you are covered, the employee still has to qualify.

An FMLA-eligible employee has worked for you for at least 12 months — the months need not be consecutive — and has at least 1,250 hours of service in the 12 months before the leave starts, and works at a site where you employ 50 or more employees within 75 miles of that worksite.

The 75-mile test counts your employees within 75 miles of the employee's worksite, so a multi-location group can clear it with several offices that are each far under 50 on their own.

The count is fixed when the employee gives notice of the need for leave, and leave that has already started cannot be ended because your headcount later drops below 50.

What an eligible employee gets: a total of 12 workweeks of leave in any 12-month period for qualifying reasons, which include the birth of a child and care of the newborn.

What the employee does not federally get is pay — the Department of Labor notes there is currently no federal law providing or guaranteeing paid family and medical leave for private-sector workers, though some states run their own paid leave programs.

The FMLA is job protection; the paycheck question belongs to the state programs below.

Where 50 sits on the wider ladder of federal thresholds, and how to count part-time staff and multiple worksites toward it, is the subject of our guide to which laws apply.

State law is where the 50-employee line stops being the answer.

The clearest documented example is California, whose own family leave law reaches employers one-tenth the federal size.

The California Family Rights Act covers any employer that directly employs five or more persons.

An employee with more than 12 months of service and at least 1,250 hours in the previous 12 months may take up to 12 workweeks of family care and medical leave in a 12-month period.

Note what is missing compared with the FMLA: California has no 50-employees-within-75-miles test.

A five-person California practice can owe job-protected family care and medical leave at a headcount where the federal law never switches on.

Like the FMLA, CFRA leave is job protection; the pay question is handled by the programs in the next section.

California also runs a pregnancy-specific leave duty in the same five-employee range; that one is covered in the pregnancy section below.

California proves that state leave law can reach well below 50 employees.

If you are elsewhere, the working question is what your own state requires — your state labor department's employer pages are the place to check before you treat the FMLA threshold as the whole answer.

On pay, the Department of Labor is blunt: no federal law currently provides or guarantees paid family and medical leave for private-sector workers, though some states run their own paid leave programs.

For a practice owner, those programs turn one question into three: do you owe a premium, do you owe an insurance policy, and does the program itself protect the job?

Each state sets its own employer-size rules, benefit weeks and rates.

Here is what each program's own materials put on the employer's plate:

Read the table as three different kinds of employer duty.

In the contribution states, your job is the money flow: Washington requires employers of every size to collect premiums and report quarterly, though businesses with fewer than 50 employees do not pay the employer share; Colorado requires businesses with ten or more employees to remit the full 0.88% premium; Oregon requires all employers to withhold employee contributions, with employers of 25 or more on average also paying the employer portion.

In New York the duty is insurance plus reinstatement: most private employers with one or more employees must obtain Paid Family Leave insurance, and the employee comes back to the same or a comparable position, with no retaliation for requesting or taking the leave.

California shows why pay and job protection are separate questions.

The state's Paid Family Leave pays up to 8 weeks of benefits but does not itself provide job protection — the job protection comes from the FMLA or CFRA.

So a California hygienist can be collecting a benefit from the EDD while their job protection, if any, rides on a different law entirely.

When you plan a leave, answer the two questions separately: who pays, and who guarantees the job.

The table lists the programs the cited sources document with current employer rules and figures — it is not a 50-state list, and the timelines move: Maine's benefits start only for time off on or after May 1, 2026, the D.C. benefit levels in the table took effect Oct.

1, 2026, and Maryland's proposed delay would push payroll deductions to January 1, 2027 and benefits to January 1, 2028.

If your state is missing from the table, check your state labor department before you assume no program applies.

Even where no leave law reaches you, pregnancy carries its own obligations, and the rung is lower than the FMLA's: the Pregnant Workers Fairness Act covers employers with 15 or more employees, as defined in Title VII.

It took effect June 27, 2023, and the EEOC regulation carrying it took effect June 18, 2024.

The PWFA is an accommodation law, not a leave law.

A covered employer must reasonably accommodate known limitations related to pregnancy, childbirth or related medical conditions unless doing so causes undue hardship — and it may not require an employee to take leave if another reasonable accommodation would let them keep working.

In practice, "take the time off" is not your default answer.

Before a pregnant front-desk coordinator or assistant goes out on leave, work through what would let them keep working given the limitation they actually describe.

Leave is one option — under the PWFA it is not the one you can force when an accommodation would keep them at work.

The states layer on more.

The EEOC counts more than 30 states and cities with laws requiring employers to accommodate pregnant workers, so the question does not disappear below 15 employees.

California runs the most concrete leave rule in this guide: a covered employer there may not refuse an employee disabled by pregnancy, childbirth or a related condition a leave of a reasonable period not exceeding four months — and that duty follows FEHA's five-employee coverage definition, so the threshold sits in the same five-employee range as CFRA.

For the practice-side detail — duties, scheduling, and the X-ray and nitrous questions that come up with pregnant staff — our guide to pregnant staff covers it.

Once the legal questions are settled, the operational one is left: the chair time, the recall schedule and the front desk have to keep running for the whole length of the leave.

Separate two problems first.

One is capacity — who covers the production while they are out.

The other is the job itself: where the leave is job-protected — the FMLA and CFRA, New York's Paid Family Leave, Maine's program once the employee has 120 consecutive days in — the plan is coverage, not replacement.

New York states the return duty plainly: the employer must reinstate the employee to the same or a comparable position when they return from Paid Family Leave, and may not retaliate for requesting or taking it.

• Cross-cover inside the team first. An assistant cross-trained on scheduling and recall keeps the front desk moving, and the hygiene schedule is easier to adjust before the leave starts than week by week.
• Buy the clinical hours you cannot cover. Temp coverage through a dental temp agency fills chair time without a permanent hire — see temp coverage for how agency costs, contracts and liability work.
• Plan the return, not just the exit. A lighter patient book for the first week or two back is easier to absorb than a full book on day one, and it gives you an early read on whether the coverage plan is holding.

Hiring your way out of a coverage gap — per diem, part-time or permanent — starts at the dental hiring hub.

Write the policy down before the first leave request lands, because every rule on this page turns on facts about your practice you can settle in advance.

• Run the counts first. The federal FMLA test is 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year — check both years, and remember the eligibility test counts employees within 75 miles.
• Name the laws that apply at your headcount. The PWFA accommodation duty starts at 15 employees; state programs have their own size rules — New York's insurance duty reaches employers with one or more employees, California's CFRA starts at five. Write down which ones cover you today and which you are close to crossing.
• State the eligibility tests you will apply. Service months and the 1,250-hour test, the notice you ask for, and how leave gets scheduled.
• Explain how pay works. Which benefits the employee can collect and from which program — and that a benefit payment is not the same thing as job protection.
• Handle the notices if you are FMLA-covered. A covered employer must post the FMLA general notice even if no employees are eligible for FMLA leave, and if it has any eligible employees it must also give the general notice to each employee — for example, by including it in the employee handbook.
• Keep the records. FMLA-covered employers must keep FMLA records for no less than three years.

Two more details belong in writing: how state paid leave benefits interact with your PTO and sick leave rules, and the return-to-work arrangement.

Then have an employment lawyer who knows your state read the policy before you publish it, and re-check the state program table once a year — its benefit figures and dates change, and Maryland's timeline is still a proposal.