Vermont 2025-2026 Regular Session

Vermont House Bill H0055 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	BILL AS INTRODUCED H.55
2	2	2025 Page 1 of 9
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5	5	VT LEG #379409 v.1
6	6	H.55 1
7	7	Introduced by Representatives Headrick of Burlington, Burrows of West 2
8	8	Windsor, Casey of Montpelier, Cina of Burlington, Cole of 3
9	9	Hartford, Logan of Burlington, McCann of Montpelier, McGill 4
10	10	of Bridport, Priestley of Bradford, Surprenant of Barnard, 5
11	11	Tomlinson of Winooski, and Waszazak of Barre City 6
12	12	Referred to Committee on 7
13	13	Date: 8
14	14	Subject: Health; health insurance; gender-affirming care; fertility treatment 9
15	15	Statement of purpose of bill as introduced: This bill proposes to expand access 10
16	16	to health insurance coverage for gender-affirming health care services. It 11
17	17	would also require health insurance plans and Vermont Medicaid to provide 12
18	18	coverage for fertility-related services and direct the Agency of Human Services 13
19	19	to seek federal approval of an amendment to Vermont’s Medicaid state plan to 14
20	20	permit the Medicaid coverage. 15
21	21	An act relating to coverage for fertility treatment and gender-affirming 16
22	22	health care services 17 BILL AS INTRODUCED H.55
23	23	2025 Page 2 of 9
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26	26	VT LEG #379409 v.1
27	27	It is hereby enacted by the General Assembly of the State of Vermont: 1
28	28	Sec. 1. 8 V.S.A. § 4088m is amended to read: 2
29	29	§ 4088m. COVERAGE FOR GENDER -AFFIRMING HEALTH CARE 3
30	30	SERVICES 4
31	31	(a) Definitions. As used in this section: 5
32	32	(1) “Gender-affirming health care services” has the same meaning as in 6
33	33	1 V.S.A. § 150. 7
34	34	(2) “Health care provider” has the same meaning as in 18 V.S.A. 8
35	35	§ 9402. 9
36	36	(3) “Health insurance plan” means Medicaid and any other public health 10
37	37	care assistance program, any individual or group health insurance policy, any 11
38	38	hospital or medical service corporation or health maintenance organization 12
39	39	subscriber contract, or any other health benefit plan offered, issued, or renewed 13
40	40	for any person in this State by a health insurer as defined by 18 V.S.A. § 9402. 14
41	41	For purposes of this section, health insurance plan includes any health benefit 15
42	42	plan offered or administered by the State or any subdivision or instrumentality 16
43	43	of the State. The term does not include benefit plans providing coverage for a 17
44	44	specific disease or other limited benefit coverage, except that it includes any 18
45	45	accident and sickness health plan. 19
46	46	(b) Coverage. 20 BILL AS INTRODUCED H.55
47	47	2025 Page 3 of 9
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50	50	VT LEG #379409 v.1
51	51	(1)(A) A health insurance plan shall provide coverage for gender-1
52	52	affirming health care services that: 2
53	53	(A) are medically necessary and clinically appropriate for the 3
54	54	individual’s diagnosis or health condition; and, as determined by the covered 4
55	55	individual’s treatment health care provider. Medically necessary gender-5
56	56	affirming health care services shall include, if determined by the treating health 6
57	57	care provider to be clinically appropriate for a covered individual: 7
58	58	(i) facial masculinization and feminization procedures; and 8
59	59	(ii) facial hair removal, such as laser hair removal or electrolysis. 9
60	60	(B) are included in the State’s essential health benefits benchmark 10
61	61	plan A health insurance plan shall not impose barriers to accessing gender-11
62	62	affirming health care services, such as mandating a specific duration of 12
63	63	hormone therapy or requiring correspondence from more than one health care 13
64	64	provider before authorizing gender-affirming surgery or other gender-affirming 14
65	65	health care services. 15
66	66	(2) Coverage provided pursuant to this section by Medicaid or any other 16
67	67	public health care assistance program shall comply with all federal 17
68	68	requirements imposed by the Centers for Medicare and Medicaid Services. 18
69	69	(3) Nothing in this section shall prohibit a health insurance plan from 19
70	70	providing greater coverage for gender-affirming health care services than is 20
71	71	required under this section. 21 BILL AS INTRODUCED H.55
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75	75	VT LEG #379409 v.1
76	76	(c) Cost sharing. A health insurance plan shall not impose greater 1
77	77	coinsurance, co-payment, deductible, or other cost-sharing requirements for 2
78	78	coverage of gender-affirming health care services than apply to the diagnosis 3
79	79	and treatment of any other physical or mental condition under the plan. 4
80	80	(d) On or before January 15 of each year, the Department of Financial 5
81	81	Regulation shall report to the House Committee on Health Care and the Senate 6
82	82	Committees on Health and Welfare and on Finance on health insurance plans’ 7
83	83	compliance with this section, utilization of gender-affirming health care 8
84	84	services during the previous calendar year, and any identified barriers to access 9
85	85	to care. 10
86	86	Sec. 2. 8 V.S.A. § 4099f is added to read: 11
87	87	§ 4099f. FERTILITY-RELATED SERVICES 12
88	88	(a) Definitions. As used in this section: 13
89	89	(1) “Experimental fertility procedure” means a procedure for which the 14
90	90	published medical evidence is not sufficient for the American Society for 15
91	91	Reproductive Medicine, its successor organization, or a comparable 16
92	92	organization to regard the procedure as established medical practice. 17
93	93	(2) “Fertility diagnostic care” means procedures, products, medications, 18
94	94	and services intended to provide information about an individual’s fertility, 19
95	95	including laboratory assessments and imaging studies. 20 BILL AS INTRODUCED H.55
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99	99	VT LEG #379409 v.1
100	100	(3) “Fertility preservation services” means procedures, products, 1
101	101	medications, and services intended to preserve fertility, consistent with 2
102	102	established medical practice and professional guidelines published by the 3
103	103	American Society for Reproductive Medicine, its successor organization, or a 4
104	104	comparable organization, for an individual who has a medical or genetic 5
105	105	condition or who is expected to undergo treatment that may directly or 6
106	106	indirectly cause a risk of impairment of fertility. “Fertility preservation 7
107	107	services” includes the procurement and cryopreservation of gametes, embryos, 8
108	108	and reproductive material and storage from the time of cryopreservation for a 9
109	109	period of five years. Storage may be offered for a longer period of time. 10
110	110	(4) “Health care provider” has the same meaning as in 18 V.S.A. 11
111	111	§ 9402. 12
112	112	(5) “Health insurance plan” means any individual or group health 13
113	113	insurance policy; any hospital or medical service corporation or health 14
114	114	maintenance organization subscriber contract; or any other health benefit plan 15
115	115	offered, issued, or renewed for any person in this State by a health insurer. 16
116	116	The term does not include benefit plans providing coverage for specific 17
117	117	diseases or other limited benefit coverage. 18
118	118	(6) “Health insurer” has the same meaning as in 18 V.S.A. § 9402. 19
119	119	(b) Required coverage. A health insurance plan shall provide coverage for 20
120	120	the following fertility-related services for all insureds: 21 BILL AS INTRODUCED H.55
121	121	2025 Page 6 of 9
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124	124	VT LEG #379409 v.1
125	125	(1) Fertility diagnostic care. 1
126	126	(2) Intrauterine insemination treatment with donor or partner semen. 2
127	127	(3) At least three retrievals of oocytes under anesthesia for in vitro 3
128	128	fertilization (IVF) with donor or partner semen or egg, including appropriate 4
129	129	medications for ovarian stimulation; unlimited embryo transfers; and IVF-5
130	130	related laboratory procedures, ultrasounds, and hormones. A health insurance 6
131	131	plan may, but shall not be required to, provide coverage for preimplantation 7
132	132	genetic testing as a component of IVF. 8
133	133	(4) Clinically appropriate fertility-related medications as ordered or 9
134	134	prescribed by the insured’s treating health care providers. 10
135	135	(5) Fertility preservation services. 11
136	136	(c) Access to services; limitations on coverage. 12
137	137	(1) A health insurance plan shall not establish any rate, term, or 13
138	138	condition that places a greater financial burden on an insured for access to 14
139	139	fertility-related services than for access to treatment for any other health 15
140	140	condition. 16
141	141	(2) A health insurance plan shall not impose any limitations on coverage 17
142	142	for any fertility services based on an insured’s use of donor sperm or eggs, 18
143	143	donor embryos, or surrogacy. 19
144	144	(3) A health insurance plan is not required to provide coverage for: 20
145	145	(A) any experimental fertility procedure; or 21 BILL AS INTRODUCED H.55
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149	149	VT LEG #379409 v.1
150	150	(B) any nonmedical costs related to donor sperm or eggs, donor 1
151	151	embryos, or surrogacy. 2
152	152	(d) Reporting. On or before January 15 of each year, the Department of 3
153	153	Financial Regulation shall report to the House Committee on Health Care and 4
154	154	the Senate Committees on Health and Welfare and on Finance on health 5
155	155	insurance plans’ compliance with this section, utilization of fertility-related 6
156	156	services during the previous calendar year, and any identified barriers to access 7
157	157	to care. 8
158	158	Sec. 3. 33 V.S.A. § 1901n is added to read: 9
159	159	§ 1901n. COVERAGE OF FERTILITY-RELATED SERVICES 10
160	160	(a) Definitions. As used in this section: 11
161	161	(1) “Fertility diagnostic care” and “fertility preservation services” have 12
162	162	the same meanings as in 8 V.S.A. § 4099f. 13
163	163	(2) “Health care provider” has the same meaning as in 18 V.S.A. 14
164	164	§ 9402. 15
165	165	(b) Coverage. The Agency of Human Services shall provide Medicaid 16
166	166	coverage for the following fertility-related services for all Medicaid 17
167	167	beneficiaries: 18
168	168	(1) Fertility diagnostic care. 19
169	169	(2) Intrauterine insemination treatment with donor or partner semen. 20 BILL AS INTRODUCED H.55
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173	173	VT LEG #379409 v.1
174	174	(3) At least three retrievals of oocytes under anesthesia for in vitro 1
175	175	fertilization (IVF) with donor or partner semen or egg, including appropriate 2
176	176	medications for ovarian stimulation; unlimited embryo transfers; and IVF-3
177	177	related laboratory procedures, ultrasounds, and hormones. The Agency may, 4
178	178	but shall not be required to, provide Medicaid coverage for preimplantation 5
179	179	genetic testing as a component of IVF. 6
180	180	(4) Clinically appropriate fertility-related medications as ordered or 7
181	181	prescribed by the beneficiary’s treating health care providers. 8
182	182	(5) Fertility preservation services. 9
183	183	Sec. 4. COVERAGE FOR FERTILITY-RELATED SERVICES; MEDICAID 10
184	184	STATE PLAN AMENDMENT 11
185	185	On or before September 1, 2025, the Agency of Human Services shall 12
186	186	request approval from the Centers for Medicare and Medicaid Services to 13
187	187	amend Vermont’s Medicaid state plan to include coverage for fertility-related 14
188	188	services as set forth in Sec. 3 of this act. 15
189	189	Sec. 5. EFFECTIVE DATES 16
190	190	(a) Secs. 1 (8 V.S.A. § 4088m) and 2 (8 V.S.A. § 4099f) shall take effect 17
191	191	on January 1, 2026 and shall apply to all health insurance plans issued on and 18
192	192	after January 1, 2026 on such date as a health insurer offers, issues, or renews 19
193	193	the health insurance plan, but in no event later than January 1, 2027. 20 BILL AS INTRODUCED H.55
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197	197	VT LEG #379409 v.1
198	198	(b) Sec. 3 (33 V.S.A. § 1901n) shall take effect upon approval by the 1
199	199	Centers for Medicare and Medicaid Services of Vermont’s request to provide 2
200	200	coverage of fertility-related services as set forth in that section. 3
201	201	(c) Sec. 4 (coverage for fertility-related services; Medicaid state plan 4
202	202	amendment) and this section shall take effect on passage. 5