Appendix 2: Medicaid

Appendix 2: State Medicaid Coverage of Infertility Services

Covered and Non-Covered Services by State
(As of January 2020)

AL Not Covered: Infertility services or treatment (Covered Services Handbook)
AK Not Covered: Infertility services. Drugs used to treat infertility (Provider Billing Manual)
AZ Not Covered: Services for the diagnosis or treatment of infertility are not covered (Provider Manual)
AR No mention of infertility services (Provider Manuals, Family Planning Guidelines or Policy Manual)
CA Not Covered: Infertility studies/procedures for diagnosing/treating infertility (Family Planning Manual)
CO Covered: Basic fertility and reproductive health counseling is provided (Family Planning Services Benefits)

Not Covered: Sterilization reversal. Infertility treatment, counseling and testing. Tests normally associated with infertility management (e.g., HSG and semen analysis) covered only to confirm success of a sterilization

CT Covered: Lab tests to detect the presence of conditions affecting reproductive health (Member Handbook)

Not Covered: Infertility treatment: sterilization reversal, IVF, IUI, cryopreservation, fertility drugs

DE Not Covered: Infertility treatment (Medicaid Managed Care Master Service Agreement*)
DC Not Covered: Infertility treatment (Covered Services guide)
FL Not Covered: Infertility evaluation or treatment (Reproductive Services Policies)
GA Covered: Infertility assessment: history/physical, education, lab testing, counseling, referral (Policies)

Not Covered: Infertility procedures and related services (Hospital Services Policies)

HI* Covered: Infertility assessment/some diagnostics covered by HMSA, Ohana and Kaiser Permanente plans

Not Covered: No infertility services covered by AlohaCare. No infertility treatment covered AlohaCare, HMSA, Kaiser Permanente, Ohana, UnitedHealthcare Medicaid plans.

ID Not Covered: Fertility services, fertility medications (Member Handbook)
IL Not Covered: Diagnostic/therapeutic procedures for primary infertility or sterility (Provider Handbook)
IN Not Covered: Fertility counseling, treatment (IUI, IVF, drugs, sterilization reversal (Provider Manual)
IA Not Covered: Fertility drugs (FFS Member Handbook) [No mention of infertility in managed care handbook]
KS* Not Covered: Infertility treatment for UnitedHealthcare, Aetna and Sunflower Health Plan Medicaid plans. Diagnosis specifically excluded by Sunflower Health Plan.
KY Not Covered: IVF. Fertility drugs (Member Handbook)
LA* Covered: Education on fertility regulation (LA Healthcare Connections, Aetna, Healthy Blue)

Not Covered: Fertility drugs (Services Chart). No treatment for infertility for Aetna. No infertility diagnosis/treatment for LA Healthcare Connections. No mention of infertility by other plans (Healthy Blue, UnitedHealthcare, AmeriHealth Caritas)

ME Not Covered: Infertility evaluation and treatment (Benefits Manual)
MD Not Covered: No fertility treatment for Amerigroup Community Care, Aetna, Physicians care, Kaiser Permantente, Medstar, Priority Partners, University of MD. No infertility services in family planning program.
MA Covered: Diagnosis of male or female infertility (MassHealth manual)

Not Covered: Treatment of infertility (lab tests, drugs, procedures) (MassHealth manual)

MI Covered: Limited infertility screening and diagnosis (Provider Manual)

Not Covered: Infertility treatment. Anesthesia related to infertility treatment. Genetic testing for infertility.

MN Covered: Counseling for and diagnosis of infertility, including related services (Member Coverage)

Not Covered: IUI, IVF, fertility drugs and related services. Sterilization reversal (Services)

MS Not Covered: IVF, IUI, sterilization reversal, cryopreservation, fertility drugs (State plan handbook)
MO Not Covered: Infertility treatment, sterilization reversal (FFS handbook). Fertility drugs (Drug list)
MT Not Covered: Fertility drugs (Prescription benefits) Infertility services, sterilization reversal (Member guide)
NE Covered: infertility diagnosis/treatment when infertility is a symptom of a suspected medical problem (e.g., thyroid disease). No coverage if the sole purpose is achieving pregnancy (Physician services)

Not Covered: Fertility drugs (Pharmacy Services)

NV* Not Covered: Fertility drugs (Prescribed Drugs Manual, Anthem BCBS) No fertility diagnosis/treatment for Health Plan, SilverSummit) No services for using a surrogate to achieve pregnancy (SilverSummit)
NH* Covered: Infertility services if related to diagnosis/treatment of medical conditions (NH Healthy Families, AmeriHealth Caritas, Well Sense)

Not Covered: Operations/procedures and medications for the purpose of fertility (Medicaid services) No infertility treatment for NH Healthy Families and Well Sense. No fertility drugs for AmeriHealth Caritas

NJ Not Covered: Infertility diagnosis, treatment, related office visits (Medicaid Contract with Managed Care)
NM* Covered: The evaluation of infertility for Presbyterian Health Plan

Not Covered: Infertility treatment for Presbyterian Health Plan. All infertility services/treatment for BCBS of NM, Western Sky Community Care

NY Covered: infertility office visits, diagnosis (HSG, pelvic ultrasounds, lab tests), fertility drugs (bromocriptine, clomiphene citrate, letrozole, tamoxifen). Limited to 3 cycles of treatment per lifetime (Infertility Benefit)

Not Covered: Infertility treatments beyond those described above.

NC Not Covered: Infertility services and related procedures. Services to manage/treat complications of women’s health problems, including heavy bleeding or infertility (Family Planning Services)
ND Not Covered: Diagnostic, medical, surgical or pharmaceutical services related to infertility. Removal of long acting reversible contraceptive devices to regain fertility (Provider manual)
OH Not Covered: Infertility services (Buckeye, CareSource, Molina Healthcare, Paramount Advantage, UHC)
OK Not Covered: Fertility treatments (Provider Guidelines). Infertility services not covered diagnosis/CPT codes (SoonerPlan)
ORⱡ Not Covered: Fertility drugs (Medicaid State Plan) Services to help you become pregnant (Member Handbook)
PA* Not Covered: Infertility services (AmeriHealth Caritas, United Healthcare, Keystone First Health Plan, UPMC for You). Infertility procedures (Geisinger Health Plan) No mention of infertility by Aetna Better Health and Health Partners of Philadelphia
RI* Not Covered: infertility treatment (Neighborhood Health Plan, United Healthcare, Tufts Health Plan)
SC Not Covered: Medications, tests, services/procedures for infertility diagnosis/treatment (Provider manual)
SD Not Covered: Fertility counseling, lab/genetic testing, fertility drugs, sterilization reversal, IUI (Family planning manual, Provider manual)
TN Not Covered: Infertility services (home ovulation kits, fertility drugs, IUI, purchase of donor sperm/eggs, cryopreservation, sterilization reversal, gestational carriers, etc.) (TennCare Medicaid)
TX* Not Covered: Diagnosis codes for infertility (Z31-) not required codes. Several surgeries not covered if for infertility (Services Handbook). Fertility treatment not covered by MyAmerigroup, BCBS, Community First Health Plan, Driscoll Health Plan, El Paso Health Plan, Molina Health Care , Superior Health Plan. No mention of infertility services by Aetna, RightCare, United Healthcare.
UT Not Covered: Sterilization reversal. Infertility studies, IVF, IUI, surrogacy (Physician Services Manual)
VT Not Covered: Fertility services/treatments (Managed Care, Pharmacy manual, Provider manual).
VA Not Covered: Will not pay for medical procedures if goal is fertility (semen analysis, fallopian tube repair, laparoscopy). Covered if reproductive system disease requires treatment to maintain overall health, and is medically necessary (Provider Manual). No fertility drugs (Pharmacy manual)
WA Not Covered: Care, testing, or treatment of infertility (Physician Related Services)
WV Not Covered: Fertility services such as cryopreservation, fertility drugs (Laboratory services, Pharmacy services). Family planning does not include fertility services (Reproductive Health Services)
WI Not Covered: Infertility treatments, surrogacy and related services (Anthem, Dean Care, Group Cooperative of South Central Wisconsin, iCare, MHS Health , Mercy Care , Security Health Plan, Forward Health, Quartz, United HealthCare). Fertility drugs (Covered services supplement).
WY Not Covered: Infertility testing, counseling, treatments (Pharmacy Services, Provider manual)
NOTES: * Benefits vary between Medicaid managed care plans. Information collected on individual Medicaid managed care plans when information on fertility benefits not found in member benefits or provider manuals pertaining to all Medicaid plans.
ⱡ OR covers basic infertility counseling as part of The Oregon Reproductive Health Program for low income women, but not a Medicaid benefit
SOURCES: Information compiled from member handbooks and provider manuals as linked above, available online as of January 2020 (see links above).
Appendix 1: Private Insurance

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