Office of Legislative Services
State House Annex
P.O. Box 068
Trenton, New Jersey 08625
Legislative Budget and Finance Office
Phone (609) 847-3105
Fax (609) 777-2442
www.njleg.state.nj.us
LEGISLATIVE FISCAL ESTIMATE
[First Reprint]
ASSEMBLY, No. 4654
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: JULY 3, 2024
SUMMARY
Synopsis: Requires health benefits coverage for family planning and
reproductive health care services, including early infancy care, without
cost sharing.
Type of Impact: Annual State and local government expenditure increases.
Agencies Affected: Department of the Treasury; Department of Human Services.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Expenditure Increase for NJ FamilyCare At least $2.9 million
State Expenditure Increase for SHBP/SEHBP Up to $4.1 million
Local Expenditure Increase for SHBP/SEHBP Up to $1.3 million
The Office of Legislative Services (OLS) estimates that requiring the State Medicaid program,
also known as NJ FamilyCare, to provide coverage for family planning and reproductive health
care services, including abortion services, without cost sharing will result in annual State
expenditure increases of at least $2.9 million. The OLS does not anticipate that the bill’s
provisions regarding coverage for family planning services will impact costs for the NJ Family
Care program.
The OLS estimates that requiring the State Health Benefits Program and the School
Employees’ Health Benefits Program to provide coverage for family planning and reproductive
health care services, including genetic testing, without cost sharing for in-network care will
increase annual costs to the State by up to $4.1 million and annual costs to local governments
by up to $1.3 million. The OLS does not anticipate that the bill’s provisions regarding coverage
for abortion services will impact costs for the State Health Benefits Program or School
Employees’ Health Benefits Program.
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BILL DESCRIPTION
This bill requires all hospital and medical benefits contracts offered in this State, including
those providing for the administration of health benefits in connection with the State Health
Benefits Program and School Employees’ Health Benefits Program, and the NJ
FamilyCare/Medicaid program, to provide coverage for family planning and reproductive health
care services without cost sharing when these services are obtained through an in-network
provider.
Pursuant to the bill, “family planning and reproductive health care services” include the
following services: abortion; emergency services; family planning counseling; family planning lab
tests; genetic testing and coverage for patients to see a licensed genetic counselor; inpatient
hospital care; laboratory and x-ray services; well-baby medical care; and ultrasound testing.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that requiring the State Medicaid program, also known as NJ FamilyCare,
to provide coverage for family planning and reproductive health care services, including abortion
services, without cost sharing will result in annual State expenditure increases of at least $2.9
million. Under current law, the State Medicaid program is permitted to cover abortions for
enrollees with the use of State funds only when the abortion is medically necessary, which limits
utilization of the procedure. NJ FamilyCare already provides coverage for the family planning
services required under the bill at little to no cost to program participants. As a result, the OLS
anticipates that the primary cost impact to the State Medicaid program under the bill will occur via
increased utilization of abortion care services provided through the NJ FamilyCare program.
No federal Medicaid reimbursements are available for abortion services because of the
prohibitions on the use of federal funds for abortion under the Hyde Amendment. As such, the
State would bear the entire fiscal impact.
The OLS anticipates that requiring the State Health Benefits Program and the School
Employees’ Health Benefits Program to provide coverage for family planning and reproductive
health care services, including genetic testing, without cost sharing for in-network care will
increase annual costs to the State by up to $4.1 million and annual costs to local governments by
up to $1.3 million. The OLS does not have the information to determine the number of prenatal
genetic tests administered to persons covered under the State Health Benefits Program and School
Employees’ Health Benefits Program each year, but notes that plan paid coverage for such services
is currently limited. Data from national and other state sources indicate that up to fifty percent of
pregnant persons may choose to undergo prenatal genetic screening.
The OLS is unable to determine whether ultrasounds provided as part of in-network prenatal
care require cost sharing. The impact of this provision on State costs for the State Health Benefits
Program and School Employees’ Health Benefits Program is therefore indeterminate.
The OLS does not expect that the bill’s provisions regarding coverage for abortion services
will impact costs for the State Health Benefits Program or School Employees’ Health Benefits
Program. Currently, both programs cover the cost of in-network elective abortions at 100 percent FE to A4654 [1R]
3
after a $30 copay. The OLS does not have the information to determine the number of procedures
covered by the State Health Benefits Program and School Employees’ Health Benefits Program
annually, but concludes that the overall cost increase to the programs for abortion services will be
minimal.
Section: State Government
Analyst: Anna Harris
Assistant Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).