Bill

Bill > S797


NJ S797

NJ S797
Requires Medicaid coverage for ovulation enhancing drugs and medical services related to administering such drugs for certain beneficiaries experiencing infertility.


summary

Introduced
01/13/2026
In Committee
01/13/2026
Crossed Over
Passed
Dead

Introduced Session

2026-2027 Regular Session

Bill Summary

This bill requires Medicaid coverage for ovulation enhancing drugs and the medical services related to administering such drugs for certain beneficiaries who are experiencing infertility. In doing so, this bill mirrors the existing infertility benefit provided under Medicaid in New York. Specifically, the bill mandates that Medicaid is to provide coverage for expenses incurred in the provision of medically necessary ovulation enhancing drugs and the medical services related to prescribing and monitoring the use of such drugs for individuals 21 through 44 years of age who are experiencing infertility, provided that there is federal financial participation available. As defined under the bill, "infertility" means a condition characterized by the incapacity to conceive, as defined by either: the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse for individuals 21 through 34 years of age; or the failure to establish a clinical pregnancy after six months of regular, unprotected sexual intercourse for individuals 35 through 44 years of age. Medical services covered under the bill are limited to office visits, hysterosalpingograms, pelvic ultrasounds, and blood testing. A hysterosalpingogram is an x-ray procedure used to see whether the patient's fallopian tubes are open and if the inside of the uterus is normal. Moreover, coverage of ovulation enhancing drugs and medical services under the bill is limited to three cycles of treatment per lifetime of the beneficiary.

AI Summary

This bill mandates that Medicaid will cover ovulation-enhancing drugs and related medical services for beneficiaries aged 21 to 44 experiencing infertility, provided federal funding is available, mirroring an existing benefit in New York. Infertility is defined as the inability to conceive, specifically the failure to achieve a clinical pregnancy after 12 months of unprotected intercourse for those aged 21-34, or after six months for those aged 35-44. Covered medical services include office visits, hysterosalpingograms (an X-ray to check fallopian tubes and uterus), pelvic ultrasounds, and blood tests. The coverage for both drugs and services is limited to a maximum of three treatment cycles per beneficiary's lifetime.

Committee Categories

Health and Social Services

Sponsors (2)

Last Action

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/13/2026)

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