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Bill

A 2281

Requires Medicaid coverage for fertility preservation services in cases of iatrogenic infertility caused by medically necessary treatments.

2026-2027 Regular Session Introduced by Rosy Bagolie and 12 co-sponsors

Medicaid would cover standard fertility preservation one cycle when medically necessary treatments may cause infertility, with rules on billing, eligibility, and implementation.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 2281

Summary of Bill A 2281 (Session 222, New Jersey)

Proposed by New Jersey lawmakers, Bill A 2281 would require Medicaid coverage for standard fertility preservation services when medically necessary treatments may cause iatrogenic infertility. The measure applies to the state’s Medicaid program and Plan First (the family planning program).

1) Purpose and Intent

  • Establish Medicaid coverage for standard fertility preservation services in cases where a medically necessary treatment (such as surgery, radiation, or chemotherapy) could directly or indirectly cause infertility.
  • Ensure individuals facing iatrogenic infertility have access to fertility preservation options without bearing the full cost, subject to the bill’s limits.

2) Key Provisions and Changes

  • Coverage Scope (New Paragraph 28, Section 6):

    • Grants coverage for “standard fertility preservation services” for medically necessary treatments that may cause iatrogenic infertility.
    • Coverage is limited to one fertility preservation cycle, unless that cycle is unsuccessful.
    • Benefits are not to be denied or limited based on life expectancy, disability, health status, age, gender, gender identity, sexual orientation, or marital status.

  • Definitions:

    • “Iatrogenic infertility”: infertility impairment caused by medical treatment affecting reproductive organs/processes.
    • “Standard fertility preservation services”: procedures aligned with established medical practices and professional guidelines (ASRM, ASCO, or New Jersey Department of Health definitions).

  • Payment and Provider Rules (Paragraph 28, Section 6, subsection c):

    • Payments for fertility preservation services are made as full payment by the Medicaid program, with providers certifying no additional charges to recipients or families.
    • If a service is deemed medically unnecessary, providers cannot seek reimbursement from the recipient or family, though they may charge for non-authorized services if the recipient knowingly receives them.

  • Eligibility and Coordination:

    • Coverage applies to eligible Medicaid recipients under the standard rules and is subject to applicable federal participation and state plan amendments/waivers.

  • Implementation and Administration:

    • The Commissioner of Human Services must pursue necessary state plan amendments or waivers to implement the act and secure federal financial participation.
    • The Commissioner must adopt implementing rules and regulations under the Administrative Procedure Act.

  • Effective Date:

    • The act would take effect immediately upon enactment.

3) Who Is Affected

  • Eligible Medicaid beneficiaries (including Plan First participants) who face iatrogenic infertility due to medically necessary treatments.
  • Medicaid providers offering fertility preservation services (e.g., fertility clinics, hospitals, and associated specialists).
  • The New Jersey Department of Health and the Division of Medical Assistance and Health Services for program design, waivers, and monitoring.

4) Procedural and Timeline Aspects

  • Requires state plan amendments/waivers to obtain federal financial participation.
  • Needs rulemaking by the Commissioner of Human Services to implement procedures and guidelines.
  • Effective date is immediate upon enactment (contingent on regulatory and federal approvals where applicable).

Overall, A 2281 aims to expand Medicaid to cover standard fertility preservation when medically necessary treatments threaten fertility, with a one-cycle limit unless unsuccessful, and establishes clear billing and eligibility parameters.

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

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