WeVote
Log In

Bill

JC

Bill

HB 6048

Human services: medical services; Medicaid coverage for fertility preservation; provide for.

2023-2024 Regular Session Introduced by Jaime Churches

Medicaid in Michigan would cover fertility services (diagnostic care, IUI, ovulation drugs) to pursue a live birth, with a future look at IVF and fertility preservation.

bill electronically reproduced 11/07/2024
#health:other #health:planning #humanservices:medicalservices
0
WeVote Research Nonpartisan
Bill Summary · HB 6048

Summary of HB 6048 (Michigan)

A proposed amendment to the Social Welfare Act adds fertility-related coverage under Michigan's Medicaid program, with a phased implementation starting in 2026 and a mandated legislative report on potential broader coverage options, including IVF and fertility preservation.

Purpose and intent

  • Establish Medicaid coverage for fertility services to support individuals seeking treatment for infertility, with a goal of achieving a live birth.
  • Ensure non-discrimination in eligibility and access to covered services.
  • Evaluate future expansion to include in vitro fertilization (IVF) and standard fertility preservation services under federal law.

Key provisions

  • New Sec. 109p: Beginning January 1, 2026, the Department of Health and Human Services shall provide Medicaid coverage for:
    • Fertility diagnostic care
    • Intrauterine insemination (IUI)
    • Medically necessary ovulation-enhancing drugs and related prescribing/monitoring services
    • These services must support the treatment of infertility to achieve a pregnancy resulting in a live birth, with a lifetime limit of at least 3 cycles of ovulation-enhancing medication treatment.
  • Non-discrimination: Coverage must be provided without discrimination based on age, ancestry, disability, domestic partner status, gender, gender identity or expression, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
  • Post-implementation reporting (within 180 days after the amendatory act’s effective date, after CMS consultation): The Department must report to the Legislature on:
    • Whether IVF and standard fertility preservation services are medically reasonable and necessary under federal law
    • Possible methods to cover IVF and standard fertility preservation for both fee-for-service and managed care
    • Any applicable waiver authorities
    • The funding required from federal and local funds to implement coverage
  • Definitions (for Sec. 109p), including:
    • Fertility diagnostic care
    • Gamete
    • Health care provider (nurse practitioner, physician, or physician’s assistant)
    • Infertility (various clinical criteria and age-based benchmarks)
    • Intrauterine insemination
    • Physician
    • Standard fertility preservation services

Coverage scope and providers

  • Applies to medical assistance recipients (Medicaid) in Michigan.
  • Coverage applies to services delivered by eligible health care providers (as defined in the bill).
  • Involves both fee-for-service and managed care arrangements as potential coverage models, subject to federal compliance.

Timeline and implementation

  • Effective date for coverage: January 1, 2026.
  • Initial reporting obligation: within 180 days after the effective date of the amendatory act adding Sec. 109p; CMS consultation required.

Affected parties

  • Medicaid/Low-income individuals seeking fertility treatment in Michigan.
  • Health care providers (Nurse practitioners, physicians, physician assistants) who deliver fertility-related services.
  • Managed care organizations and fee-for-service Medicaid delivery systems.

Financial considerations

  • No explicit funding amount in the bill text; the required CMS-consulted report must outline the funding needs and potential waiver strategies to support coverage.

Legislative status

  • Introduced: November 7, 2024 by Rep. Churches.
  • Referred to Health Policy; read for the first time on November 7, 2024. Electronically reproduced on November 7, 2024.

This bill would meaningfully expand Medicaid coverage to key fertility services in Michigan, with a defined path to broader coverage contingent on federal compatibility and legislative budgeting.

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

Sign in to ask a question.