Oct 31, 2023 - News

Infertility treatments could become more inclusive, accessible for Californians

States where IVF and infertility are insured
Data: Resolve; Map: Thomas Oide/Axios

A new, more expansive definition of "infertility" could bring help to hopeful LGBTQ+ and single parents in California and beyond.

Why it matters: Redefining the condition could lead to broader insurance coverage of fertility services like egg freezing and in vitro fertilization for all people who need help starting families — not just heterosexual couples.

Driving the news: The American Society for Reproductive Medicine redefined infertility to include people who need medical intervention, such as donor eggs or sperm, to achieve pregnancy.

  • It's no longer limited to when a man and a woman can't get pregnant after a year of unprotected intercourse or intrauterine insemination — or six months for women over 35.
  • The updated language applies to anyone who needs help having children, regardless of relationship status, gender identity or sexual orientation.

Between the lines: "There's been a real issue with getting access to treatment for certain causes of infertility including for single people [and] people in same-sex relationships … so it became clear that we need to explicitly address that," ASRM spokesperson Sean Tipton told Axios.

Zoom in: California only requires insurers to offer infertility treatment coverage, but that does not include IVF coverage, according to infertility advocacy group Resolve.

What we're watching: While the new "infertility" definition creates one avenue to more inclusive coverage, California legislators are pursuing another.

  • State lawmakers are considering a bill that would require health insurance plans to cover the diagnosis and treatment of infertility and fertility services, including IVF.
  • It also expands the definition of infertility to include coverage for LGBTQ+ individuals and surrogates.
  • "Historically, many cannot afford the out-of-pocket costs of treatment, and LGBTQ+ individuals have been largely excluded in California due to a hetero-normative definition of infertility," state Senator Caroline Menjivar said in a statement.
  • Yes, but: Previous legislative attempts to expand coverage to include IVF, diagnosis and treatment for single persons, same-sex couples and transgender people stalled.

Zoom out: As of now, 21 states plus Washington, D.C., require some workplace health plans to cover at least some form of fertility coverage. Of those, only eight states have policies inclusive of LGBTQ+ communities and single parents, according to Betsy Campbell, chief engagement officer at Resolve.

State of play: Despite the growing interest in fertility care — and more employers offering fertility benefits to stay competitive in the labor market — insurance coverage for the often-expensive services remains limited.

What they're saying: A more inclusive definition of infertility is "a game-changer," because a number of insurance plans rely on the ASRM definition of what's a disease to determine coverage, infertility specialist Lucky Sekhon told Axios.

  • With this update, "insurance companies can't discriminate. … It gives people ammunition to fight policies for more coverage," she says.
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