WeVote
Log In

Bill

RB

Bill

A 1207

Requires unrestricted Medicaid coverage for ovulation enhancing drugs and medical services related to administering such drugs for certain beneficiaries experiencing infertility.

2026-2027 Regular Session Introduced by Rosy Bagolie and 5 co-sponsors

Extends NJ Medicaid to cover ovulation-enhancing drugs and related services for infertility, up to three cycles per person, contingent on federal participation.

Reported out of Assembly Committee, 2nd Reading
0
WeVote Research Nonpartisan
Bill Summary · A 1207

Overview

Assembly Bill A1207 (Session 222, New Jersey) would require unrestricted Medicaid coverage for ovulation-enhancing drugs and the related medical services for certain beneficiaries experiencing infertility. The measure emphasizes state plan amendments to secure federal participation and directs the Department of Human Services to adopt implementing rules.

Main purpose and intent

  • Ensure Medicaid-covered access to ovulation-enhancing drugs for infertile individuals aged 21 to 44.
  • Include the medical services necessary to prescribe and monitor those drugs (office visits, imaging, and blood tests) when there is federal financial participation.
  • Limit coverage to three treatment cycles per beneficiary lifetime.
  • Expand Medicaid to cover infertility treatment services within the broader framework of medically necessary reproductive health care, subject to federal requirements and state plan approvals.

Key provisions and changes

  • Coverage scope (new §6 of P.L.1968, c.413): Adds a specific category of services—ovulation-enhancing drugs and related medical services (prescribing/monitoring) for infertility.
  • Eligible population: Individuals aged 21 through 44 experiencing infertility.
  • Covered services (examples list): Office visits, hysterosalpingograms, pelvic ultrasounds, and blood testing.
  • Lifetime limit: Up to three cycles of ovulation-enhancing treatment per beneficiary.
  • Federal participation: Authorization contingent on available federal financial participation; the state plan must pursue amendments or waivers as needed.
  • State responsibilities:
    • The Commissioner of Human Services must apply for necessary State plan amendments or waivers.
    • Adopt rules and regulations under the Administrative Procedure Act to implement the act.
  • Effective date: Takes effect on the first day of the fourth month after enactment, with potential anticipatory actions allowed for implementation.

Who would be affected

  • Medicaid beneficiaries in New Jersey aged 21–44 who have infertility (defined by the bill as:
    • Inability to conceive after 12 months of regular, unprotected intercourse (ages 21–34); or
    • Inability to conceive after 6 months for ages 35–44).
  • Providers delivering infertility treatments and associated services (physicians, clinics, imaging and lab services) eligible for Medicaid reimbursement for these specific services.
  • State and local health administrations responsible for implementing Medicaid expansions and pursuing federal participation.

Procedural and timeline aspects

  • Legislative steps:
    • Must secure federal approvals and participate in applicable Medicaid waivers or state plan amendments.
    • Implement through rulemaking and regulatory changes.
  • Effective timeline:
    • Act would take effect on the first day of the fourth month after enactment.
    • State could begin preparatory actions ahead of that date.

Notes

  • The bill explicitly states that coverage is subject to federal participation and regulatory implementation.
  • It includes a non-discrimination stance on infertility definition, noting that relationship status or sexual orientation should not be used to deny or delay treatment.

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

Sign in to ask a question.