Creates a new federal Office of Paid Family and Medical Leave inside the Social Security Administration to run a national family and medical leave insurance program: determine eligibility, set and pay monthly benefits, prevent fraud, do outreach, and issue regulations. It also protects workers from retaliation and requires job restoration and continued health coverage in many cases.

Provides annual grants to qualifying State paid leave programs (called "legacy States") to cover benefits and some administration beginning in calendar year 2027 if states share specified program data with the federal office. Requires the agency to develop regulations with input from an advisory body and directs regular GAO studies and an initial agency report on implementation needs and databases.