COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
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Statement of Introduction
Expanding Access to Fertility Treatment Amendment Act of 2023
January 13, 2023
Today, I am proud to introduce the Expanding Access to Fertility Treatment Amendment Act of
2023, along with Councilmembers Kenyan McDuffie, Matthew Frumin, Robert C. White, Jr.,
Zachary Parker, Brianne K. Nadeau, Brooke Pinto, Janeese Lewis George, and Charles Allen. This
legislation would expand coverage provided through private insurers, Medicaid and the DC
Healthcare Alliance to include diagnosis and treatment for infertility.
About 11% of women of reproductive age and 9% of men in the United States have experienced
fertility problems, delaying their ability to start families. And yet, the cost of diagnosis and treatment
is inaccessible for many. The average in-vitro fertilization cycle can cost between $20,000 to $25,000.
In the United States, 70% of women who undergo IVF go into debt to cover the cost,
approximately 30,00 on average, which often causes treatment delays—34% of women stopped
treatment because of unaffordability.
We know that women without insurance coverage are 3 times more likely to discontinue treatment
after 1 cycle, compared to women with insurance coverage. To combat this unjust and inequitable
access to one’s human right, 20 states have passed fertility insurance coverage laws, including
neighboring Maryland and West Virginia.
State mandated coverage has been shown to increase 3-fold the use of infertility services, which is
also linked to better public health outcomes. Additionally, insurance coverage also reduces the
likelihood of births of multiples to one mother, given that the financial pressure to transfer more
than one to two embryos is reduced. This reduces the risk of complications and adverse health
effects for the mother.
In addition to these risks faced by all mothers, Black and brown moms often wade through
infertility silently and do not seek treatments like IVF as frequently as white mothers. Specifically,
according to the CDC’s most recent analysis
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, 8% of Black women age 25 to 44 seek medical help to
get pregnant, while 15% of white women do so. As mentioned, state mandated coverage is proved
to increase utilization of assisted reproductive technologies.
This bill would mandate private insurers, Medicaid, and the DC Healthcare Alliance to offer
coverage for diagnosis and treatment of infertility. This legislation explicitly prohibits health insurers
from:
1 Center for Disease Control and Prevention, “Infertility Service Use in the United States: Data From the National Survey of Family Growth, 1982–
2010” 2014. www.cdc.gov/nchs/data/nhsr/nhsr073.pdf
Christina Henderson Committee Member
Councilmember, At-Large Hospital and Health Equity
Chairperson, Committee on Health Judiciary and Public Safety
Transportation and the Environment
COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
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• Imposing additional costs, waiting periods, or other limitations on converge for the diagnosis
of infertility;
• Placing pre-existing condition exclusions or waiting periods on coverage for the treatment of
infertility, or using prior treatment for infertility as a basis for excluding, limiting or
otherwise restricting coverage; and
• Limiting on coverage for fertility treatment based on a class protected under the Human
Rights Act.
I am glad that this bill received a hearing during Council Period 24 when I first introduced it. Many
people expressed their support for the bill and outlined the positive impact it would have for people
trying to start a family.
I look forward to working with my colleagues to enhance coverage offered for future mothers and
families in the District.
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Councilmember Kenyan McDuffie Councilmember Christina Henderson 2
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Councilmember Zachary Parker Councilmember Janeese Lewis George 6
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Councilmember Robert C. White, Jr. Councilmember Charles Allen 10
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Councilmember Matthew Frumin Councilmember Brianne K. Nadeau 14
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Councilmember Brooke Pinto 18
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AN ACT 20
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 24
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To amend the Women’s Health and Cancer Rights Federal Law Conformity Act of 2000 to 28
require an individual health p29
coverage through Medicaid and the D.C. Healthcare Alliance program to provide 30
coverage for the diagnosis and treatment of infertility. 31
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 33
act may be cited as the “Expanding Access to Fertility Treatment Amendment Act of 2023”. 34
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Sec. 2. The Women’s Health and Cancer Rights Federal Law Conformity Act of 2000, 36
effective April 3, 2001 (D.C. Law 13-254; D.C. Official Code § 31-3831 et seq.) is amended to 37
add a new section 5f to read as follows: 38
“Sec. 5f. Coverage of Fertility Treatments. 39 “(a)(1) Beginning January 1, 2025, an individual health plan, group health plan, health 40
insurer, and a health insurer offering health insurance coverage through Medicaid and the D.C. 41
Healthcare Alliance program shall provide coverage for the diagnosis and treatment of infertility, 42
including in vitro fertilization. 43
“(2) Every insurer shall communicate the availability of coverage to all 44
policyholders and to all prospective group policyholders with whom they are negotiating. 45
“(b) Coverage for the treatment of infertility shall be provided without discrimination on 46
the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender 47
identity, genetic information, marital status, national origin, race, religion, sex, or sexual 48
orientation. 49
“(c) A health insurer shall not impose: 50
“(1) Deductibles, copayments, coinsurance, benefit maximums, waiting 51
periods or any other limitations on coverage for the diagnosis and treatment of infertility, 52
including the prescription of fertility medications, different from those imposed upon benefits for 53
services not related to infertility; 54
“(2) Pre-existing condition exclusions or pre-existing condition waiting periods 55
on coverage for the diagnosis and treatment of infertility or use any prior diagnosis of or prior 56
treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability 57
of coverage for required benefits; or 58
“(3) Limitations on coverage based solely on arbitrary factors including, but not 59
limited to, number of attempts, dollar amounts, age, or provide different benefits to, or impose 60
different requirements upon a class protected under the Human Rights Act of 1977, effective 61 December 13, 1977 (D.C. Law 2-38; D.C. Official Code § 2-1401.01 et seq.) than that provided 62
to, or required of, other patients. 63
“(d) Nothing in this section shall be construed to interfere with the clinical judgment of a 64
physician and surgeon. 65
“(e)(1) A health insurer offering health insurance coverage to an employer organized and 66
operating as a nonprofit entity and referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal 67
Revenue Code of 1986, approved October 22, 1986 (100 Stat. 2740; 26 U.S.C. § 68
6033(a)(3)(A)(i) or (iii)) may issue a health insurance policy that excludes coverage for methods 69
of diagnosis and treatment of infertility that are contrary to the employer’s bona fide religious 70
tenets. 71
“(2) Any health insurance policy issued pursuant to this subsection shall provide 72
written notice to each insured or prospective insured that methods of diagnosis and treatment of 73
infertility are excluded from the policy coverage. 74
“(f) For the purposes of this section, the term: 75
“(1) “Infertility” means the condition of an individual who is unable to conceive 76
or produce conception or sustain a successful pregnancy during a one-year period or such 77
treatment is medically necessary. 78
“(2) “Treatment for infertility” means procedures consistent with established 79
medical practices in the treatment of infertility by licensed physicians and surgeons, including, 80
but not limited to, diagnosis, diagnostic tests, medication, surgery, and gamete intrafallopian 81
transfer.” 82
Sec. 3. Fiscal impact statement. 83
The Council adopts the fiscal impact statement in the committee report as the fiscal 84 impact statement required by section 4a of the General Legislative Procedures Act of 1975, 85
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 86
Sec. 4. Effective date. 87
This act shall take effect following approval by the Mayor (or in the event of veto by the 88
Mayor, action by the Council to override the veto), a 30-day period of congressional review as 89
provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 90
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 91
Columbia Register. 92