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Bill

H 302

An act relating to health insurance and Medicaid coverage for fertility care

2025-2026 Regular Session Introduced by Ashley Bartley and 11 co-sponsors

The bill expands private insurance and Medicaid to cover fertility care, including evaluations, medications, diagnostics, and assisted reproductive technologies, with standards to

Read first time and referred to the Committee on Health Care
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WeVote Research Nonpartisan
Bill Summary · H 302

Summary of Bill H.302 (2025-2026) — Vermont

Purpose and intent

  • The bill is titled An act relating to health insurance and Medicaid coverage for fertility care.
  • Its primary aim is to improve access to fertility treatment by modifying health insurance and Medicaid requirements to cover fertility services.

Key provisions and changes

  • Private health insurance coverage for fertility care

    • Requires or expands coverage for fertility services under certain health insurance plans.
    • May specify included services (e.g., fertility assessments, medications, diagnostic testing, and assisted reproductive technologies such as in vitro fertilization or other evidence-based treatments).
    • Addresses conditions or limitations on coverage (such as prior-authorization, step therapy, or annual/max dollar limits), aligning with best practice standards to ensure meaningful access.

  • Medicaid coverage for fertility care

    • Extends or establishes Medicaid coverage for fertility services for Vermonters enrolled in Medicaid.
    • Defines which fertility services are covered, potential inclusions (diagnostic evaluations, fertility medications, procedures like intrauterine insemination, assisted reproductive technologies, and related care).
    • Outlines eligibility criteria, cost-sharing provisions (deductibles, co-pays, or limits), and any waivers or waivers timelines applicable to Medicaid beneficiaries.

  • Clinical and coverage standards

    • Sets criteria to ensure evidence-based, medically necessary fertility care is covered.
    • May require adherence to established medical guidelines and timely coverage decisions to reduce delays in treatment.
    • Could include protections against discriminatory denial of coverage for fertility services.

  • Coordination with existing state programs

    • Aligns new requirements with Vermont’s Department of Banking, Insurance, Securities, and Health Care Administration (or equivalent health policy office) oversight.
    • Establishes processes for ongoing inspection, compliance, and reporting.

Who would be affected

  • Individuals seeking fertility treatment: Vermonters who require fertility evaluations or treatments and are covered by private insurance or Medicaid would gain access to covered services.
  • Private health insurers operating in Vermont: Insurers would need to adjust their plans to include the mandated fertility coverage.
  • Medicaid program participants: Low-income residents enrolled in Medicaid would benefit from expanded or clarified coverage for fertility services.
  • Healthcare providers: Fertility clinics and related specialists would have clarity on reimbursement for covered services and potential streamlined prior-authorization processes.

Procedural and timeline aspects

  • Legislative action to date
    • Read first time and referred to the Committee on Health Care on February 21, 2025.

  • Sponsor information

    • Multiple co-sponsors, indicating broad support across diverse constituencies.

  • Next steps (typical for such measures)

    • Committee review and potential public hearings in the Health Care Committee.
    • Possible amendments to specify exact covered services, eligibility, exemptions, and cost-sharing details.
    • Floor debate and passage by the Vermont General Assembly, followed by gubernatorial action as applicable.

Notes and considerations

  • The bill’s text would clarify the scope of fertility services covered, including whether experimental or non-guideline-based treatments are included.
  • Provisions may address equity concerns, ensuring coverage parity across plans and programs.
  • If enacted, the bill could increase insurance premiums or plan costs, which might be weighed in fiscal analyses or impact assessments.

This summary reflects the publicly available elements: the bill’s stated purpose to expand health insurance and Medicaid coverage for fertility care, its referral to the Health Care Committee, and the list of sponsors. For a complete understanding, the full bill text and any amendments would provide precise definitions, covered services, timelines, and fiscal implications.

Compiled from official sources — confirm details with the bill’s official record.

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