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. 5000
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: FEBRUARY 18, 2025
SUMMARY
Synopsis: Requires Medicaid coverage for fertility preservation services in cases
of iatrogenic infertility caused by medically necessary treatments.
Type of Impact: Annual increase in State expenditures and revenues.
Agencies Affected: Department of Human Services.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Expenditure Increase Indeterminate
State Revenue Increase Indeterminate
The Office of Legislative Services (OLS) concludes that annual State costs will increase by an
indeterminate amount to cover standard fertility preservation services for Medicaid and Plan
First enrollees who are diagnosed with iatrogenic infertility. Since more than 95 percent of
State Medicaid program beneficiaries are enrolled in a managed care plan, and the State’s
contract with the Medicaid managed care organizations specifically precludes coverage of
services provided primarily for the diagnosis and treatment of infertility, the OLS lacks the
informational basis to determine how demand for fertility preservation services may change as
a result of the bill and how much the associated State costs would increase.
Any increase in expenditures for the State Medicaid program would lead to an increase in State
revenues, indeterminate in amount, in the form of federal reimbursements for State Medicaid
expenditures under the federal Medicaid program.
BILL DESCRIPTION
The bill requires the State Medicaid program and the Plan First program to cover standard
fertility preservation services for persons undergoing a medically necessary medical treatment that FE to A5000 [1R]
2
may, directly or indirectly, cause iatrogenic infertility. Iatrogenic infertility is as impairment of
fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting
reproductive organs or processes. Standard fertility preservation services are procedures which
are consistent with established medical practices and professional guidelines from the American
Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by
the New Jersey Department of Health.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS concludes that annual State costs will increase by an indeterminate amount to cover
standard fertility preservation services for Medicaid and Plan First enrollees of reproductive age
who are diagnosed with iatrogenic infertility. Since more than 95 percent of the State’s Medicaid
beneficiaries are enrolled in a managed care plan, and the State’s contract with the Medicaid
managed care organizations specifically precludes coverage for services provided primarily for the
diagnosis and treatment of infertility, the OLS lacks the informational basis to determine how
demand for fertility preservation services may change as a result of the bill and how much the
associated State costs would increase.
Any increase in expenditures for the State Medicaid program would lead to an increase in State
revenues, indeterminate in amount, in the form of federal reimbursements for State Medicaid
expenditures under the federal Medicaid program.
Because only five states (Illinois, Maryland, Montana, Oklahoma, and Utah) cover fertility
preservation services under their Medicaid programs, and the majority of these states have waivers
or state plan amendments pending approval by the federal Centers for Medicare and Medicaid
Services, the OLS cannot look to these states for guidance on average reimbursement rates for, or
enrollee utilization of, fertility preservation services. However, as part of its waiver application to
cover fertility preservation services for Medicaid enrollees either diagnosed with or at risk for
iatrogenic infertility, the Maryland Department of Health projected $6.4 million in increased costs
annually. Maryland anticipated that coverage for these services would begin in 2025. Also, a
2019 public notice by the state of Illinois anticipated that the state’s new Medicaid fertility
preservation benefit would increase state Medicaid costs by $5.0 million annually.
A 2019 report by the New Jersey Mandated Health Benefits Advisory Commission concerning
P.L.2019, c.306, which requires certain State-regulated health insurers to cover fertility
preservation services in cases of iatrogenic infertility, assumed that between 25 percent and 33
percent of eligible enrollees would utilize these services. These projections are likely high for the
Medicaid and Plan First populations, since the State Medicaid program currently does not provide
infertility services for enrollees. As such, most health care providers who offer fertility
preservation services are unlikely to participate in the State Medicaid program or the Plan First
program. The OLS, moreover, cannot anticipate the number of fertility specialists who may apply
to become an approved Medicaid provider subsequent to the bill.
The State’s Plan First program provides targeted family planning and family planning-related
services and supplies for individuals whose annual incomes are below 205 percent of the federal
poverty level and who are not otherwise eligible for Medicaid or the NJ FamilyCare program. FE to A5000 [1R]
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Section: Human Services
Analyst: Anne Cappabianca
Senior 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.).