Medicaid Coverage of Family Planning Benefits: Results from a State Survey
|Key Finding: Fertility Services|
|No state covers fertility treatments for either women or men. Some states cover diagnostic testing related to fertility, although some restrict the test for medical reasons other than for fertility.|
There are no federal requirements for state Medicaid programs to cover fertility testing or treatment such as medications, intrauterine insemination, or in-vitro fertilization for individuals enrolled in Medicaid. States may cover diagnostic services to detect the underlying medical reasons for infertility.
States were asked about diagnostic testing for both women (laparoscopy) and men (semen analysis). Nine of the 41 responding states cover fertility testing for women and men in their traditional Medicaid program as do 6 of the 25 responding ACA expansion states (Table 14). Just 3 of 23 states cover testing for women (Maryland, Minnesota, Oklahoma) and men (Alabama, Maryland, Minnesota) under a family planning waiver or SPA. Overall, five states provide the coverage for both genders in all of their eligibility pathways: Arkansas, Hawaii, Massachusetts, Maryland, and Nebraska. Notably, Nebraska is the only state that indicated it provides women with medication such as clomid and hCG, but only when infertility is a symptom of a separate medical problem. Appendix Tables A7 and A8 detail fertility testing policies for women and men.
|Table 14: Fertility Testing and Services in State Medicaid Programs, by Type of Program|
|ACA Medicaid Expansion
|Family Planning Waiver/SPA
|Diagnostic Testing for Women||9||6||3|
|Diagnostic Testing for Men||9||6||3|
|Medications for women (Clomid, hCG)||1||1||0|