AN ACT CONCERNING FERTILITY CARE UNDER THE MEDICAID PROGRAM.

House of Representatives
sHB5483 / File No. 428 1

General Assembly File No. 428
February Session, 2026 Substitute House Bill No. 5483

House of Representatives, April 7, 2026

The Committee on Human Services reported through REP.
GILCHREST of the 18th Dist., Chairperson of the Committee on
the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING FERTILITY CARE UNDER THE MEDICAID
PROGRAM.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. (NEW) (Effective January 1, 2027) (a) As used in this section: 1
(1) "Fertility diagnostic care" means counseling, products, 2
medications, procedures, genetic testing and services intended to 3
provide information about an individual's fertility, including, but not 4
limited to, laboratory assessments and imaging studies; 5
(2) "Infertility" means (A) the inability to establish or carry a 6
pregnancy based on an individual's medical, sexual and reproductive 7
history, age, physical findings, diagnostic testing or any combination of 8
those factors, including, but not limited to, infertility arising from 9
disabilities or from medical treatments or conditions associated with a 10
disability, (B) the need for medical intervention to establish a pregnancy 11
either as an individual or with a partner, (C) an individual's inability to 12
establish a pregnancy or carry a pregnancy to live birth after twelve 13
sHB5483 File No. 428

sHB5483 / File No. 428 2

months of unprotected sexual intercourse when the individual and the 14
individual's partner have the necessary gametes to establish a 15
pregnancy, provided a pregnancy loss shall not restart the twelve -16
month period, or (D) an individual's inability to establish a pregnancy 17
or to carry a pregnancy to live birth after six months of unprotected 18
sexual intercourse due to the individual's age when the individual and 19
the individual's partner have the necessary gametes to establish a 20
pregnancy, provided a pregnancy loss shall not restart the six -month 21
period; 22
(3) "Intrauterine insemination" means a procedure that places sperm 23
directly into an individual's uterus at the time of ovulation to increase 24
the chances of fertilization; 25
(4) "In-vitro fertilization" or "IVF" means a medical procedure where 26
an egg is fertilized by sperm in a laboratory setting; and 27
(5) "Standard fertility preservation services" means counseling, 28
products, medications, procedures, genetic testing and services 29
intended to preserve fertility, consistent with established medical 30
practice and professional guidelines published by the American Society 31
for Reproductive Medicine or the American Society for Clinical 32
Oncology, for an individual who (A) has a medical or genetic condition, 33
including, but not limited to, conditions related to disability or chronic 34
illness, or (B) is expected to receive medical treatment that has a side 35
effect or possible side effect of a risk to an individual's fertility and 36
includes, but is not limited to, expenses related to evaluation, laboratory 37
assessments, medications and treatment, as well as the procurement and 38
cryopreservation of gametes, embryos and reproductive material and 39
storage. 40
(b) Beginning on January 1, 2027, the Commissioner of Social Services 41
shall provide Medicaid coverage, to the extent permissible under federal 42
law, for: 43
(1) Fertility diagnostic care; 44
sHB5483 File No. 428

sHB5483 / File No. 428 3

(2) Standard fertility preservation services, including, but not limited 45
to, storage of gametes from the time of cryopreservation, provided 46
coverage for such storage shall extend until the individual reaches the 47
age of thirty, or for a period of five years, whichever is later, unless the 48
commissioner extends the period of time; and 49
(3) Treatment of infertility, including, but not limited to, (A) any 50
medically necessary ovulation -enhancing medications and medical 51
services related to prescribing and monitoring the use of the ovulation-52
enhancing medications for at least three cycles of ovulation -enhancing 53
medication treatment, and (B) at least six cycles of intrauterine 54
insemination. 55
(c) In implementing the coverage required in this section, the 56
Commissioner of Social Services shall not: 57
(1) Impose a waiting period; 58
(2) Use any prior diagnosis, an individual's disability or prior fertility 59
treatment as a basis for excluding, limiting or otherwise restricting the 60
availability of coverage required under this section; 61
(3) Impose any limitations on coverage for any fertility services based 62
on an individual's use of donor gametes; and 63
(4) Impose different limitations on coverage for, provide different 64
benefits to or impose different requirements on a class of persons on 65
account of their age, ancestry, color, disability, ethnicity, gender 66
identity, genetic information, marital status, national origin, race, 67
religion, sex or sexual orientation. 68
(d) The Commissioner of Social Services shall consult with the 69
Centers for Medicare and Medicaid Services on whether in -vitro 70
fertilization is a medically reasonable and necessary procedure as 71
required for Medicaid coverage under federal law. Not later than July 1, 72
2027, the commissioner shall submit a report, in accordance with the 73
provisions of section 11 -4a of the general statutes, to the joint standing 74
committee of the General Assembly having cognizance of matters 75
sHB5483 File No. 428

sHB5483 / File No. 428 4

relating to human services on (1) possible methods for covering IVF as 76
a Medicaid -covered benefit (A) for fee -for-service and managed care 77
organizations, and (B) under any applicable Medicaid waiver programs, 78
and (2) the amount of money that would need to be allocated in federal 79
and state funds for such coverage. 80
This act shall take effect as follows and shall amend the following
sections:

Section 1 January 1, 2027 New section

Statement of Legislative Commissioners:
In Subsec. (a)(2)(C), "and" was changed to "or" for accuracy; in Subsec.
(b)(2), "that" was deleted and "provided the commissioner may extend"
was changed to "unless the commissioner extends" for clarity; and in
Subsec. (d)(1)(A), "both fee-for-service" was changed to "fee-for-service"
for clarity.

HS Joint Favorable Subst. -LCO

sHB5483 File No. 428

sHB5483 / File No. 428 5

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any purpose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:
Agency Affected Fund-Effect FY 27 $ FY 28 $
Social Services, Dept. GF - Cost at least
$200,000
at least
$500,000-
$5.2 million
Note: GF=General Fund
Municipal Impact: None
Explanation
The bill results in a cost to the Department of Social Services (DSS) of
at least $200,000 in FY 27 and $500,000 to $5.2 million in FY 28 due to
requiring Medicaid coverage for fertility treatment and preservation
services, effective 1/1/27.
Medicaid currently covers family planning services that include
reproductive health exams and lab tests to detect the presence of
conditions affecting reproductive health which include infertility. While
DSS does not currently cover infertility treatment s ervices, fertility
treatment is a Medicaid coverable service and eligible for up to 90%
federal reimbursement.
Cost estimates reflect no -cycle based and medication involved
treatment, preservation services, as well as prenatal and labor and
delivery costs resulting from such treatments. In FY 28, the cost for
treatment and preservation services is estimated to be at least $500,000,
which reflects an assumed state share of 10%. The state will incur
additional costs of approximately $4.7 million (reflecting an assumed
state share of 50%) associated with prenatal, labor and delivery and
postpartum services to the extent these individuals would not otherwise
sHB5483 File No. 428

sHB5483 / File No. 428 6

become pregnant except for the fertility treatment coverage provided by
the bill.
The bill requires DSS to consult with the Centers for Medicare and
Medicaid Services on whether in-vitro fertilization (IVF) is a medically
reasonable and necessary procedure as required for Medicaid coverage
under federal law. DSS must report (by 7/1/27) to the Human Services
committee about possible ways to cover IVF under Medicaid for fee-for-
service and managed care organizations or under Medicaid waiver
programs and the necessary funding to do so. IVF costs are therefore not
included in the above estimates.
To the extent that the treatment provided under the bill is successful
and the children who would not otherwise be born are eligible for
coverage under HUSKY A or HUSKY B, the state w ill incur additional
costs.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to Medicaid coverage for fertility related
services, utilization rates and success of such treatments.

sHB5483 File No. 428

sHB5483 / File No. 428 7

OLR Bill Analysis
sHB 5483

AN ACT CONCERNING FERTILITY CARE UNDER THE MEDICAID
PROGRAM.

SUMMARY
This bill requires the Department of Social Services (DSS)
commissioner to provide Medicaid coverage, to the extent federal law
allows, for fertility diagnostic care, standard fertility preservation
services, and infertility treatment. For this coverage, t he bill prohibits
the DSS commissioner from imposing a waiting period, using a prior
diagnosis to limit or restrict coverage, or imposing certain other limits
based on use of donor gametes or personal characteristics (for example,
age, disability, or sexual orientation). Currently, Medicaid covers family
planning services, which include reproductive health exams and certain
lab tests. DSS regulations generally prohibit Medicaid reimbursement
for infertility treatment (Conn. Agencies Regs., § 17b-262-342).
The bill requires the DSS commissioner to consult with the federal
Centers for Medicare and Medicaid Services (CMS) on whether in-vitro
fertilization (IVF) is a medically reasonable and necessary procedure as
required for Medicaid coverage under federal law.
Lastly, the bill requires the DSS commissioner to report to the Human
Services Committee by July 1, 2027, on:
1. possible ways to cover IVF under Medicaid for fee -for-service
and managed care organizations or under Medicaid waiver
programs; and
2. state and federal funding needed for this coverage.
EFFECTIVE DATE: January 1, 2027
sHB5483 File No. 428

sHB5483 / File No. 428 8

MEDICAID COVERAGE FOR FERTILITY SERVICES
Fertility Diagnostic Care
DSS must provide Medicaid coverage for fertility diagnostic care,
which, under the bill, is counseling, products, medications, procedures,
genetic testing, and services to get information about a person’s fertility,
including lab tests and imaging studies.
Fertility Preservation Services
The bill requires DSS to provide Medicaid coverage for standard
fertility preservation services, which, under the bill are counseling,
products, medications, procedures, genetic testing, and services to
preserve fertility, for someone (1) with a medical or genetic condition,
including conditions related to disability or chronic illness, or (2) who is
expected to get medical treatment with possible side effects that include
risk to the person’s fertility. Services must be con sistent with
professional guideli nes by the American Society for Reproductive
Medicine or the American Society for Clinical Oncology.
Under the bill, standard fertility services include expenses related to
evaluation, lab tests, medications, treatments, gamete procurement and
cryopreservation, and reproductive material and storage.
DSS’s coverage of fertility preservation services must include gamete
storage from the time of cryopreservation for five years or when the
person reaches age 30, whichever is later, unless the DSS commissioner
extends the time.
Infertility Treatment
DSS must provide Medicaid coverage for treatment of infertility.
Under the bill, infertility is:
1. the inability to establish or carry a pregnancy based on any
combination of a person’s age, physical findings, diagnostic
testing, or medical, sexual, and reproductive history;
2. the need for medical intervention to establish a pregnancy either
as an individual or with a partner; or
sHB5483 File No. 428

sHB5483 / File No. 428 9

3. a person’s inability to establish or carry a pregnancy to live birth
after 12 months of unprotected sexual intercourse (or six months
if the inability is due to age) when the person and the person’s
partner have the necessary gametes to establish a pregnan cy
(pregnancy loss does not restart the six - or 12 -month time
period).
It includes infertility arising from disabilities or disability -related
medical treatments or conditions.
DSS’s infertility treatment coverage must include (1) any medically
necessary ovulation -enhancing medications and medical services
related to prescribing and monitoring these medications’ use for at least
three cycles and (2) at least six cycles of intraut erine insemination (a
procedure that places sperm directly into a uterus at ovulation to
increase fertilization chances).
PROHIBITED COVERAGE LIMITS
The bill prohibits DSS from limiting coverage described above by:
1. imposing a waiting period;
2. using a prior diagnosis, a person’s disability, or prior fertility
treatment as a reason to exclude, limit, or restrict coverage;
3. limiting coverage based on a person’s use of donor gametes; and
4. imposing different coverage limitations, providing different
benefits, or imposing different requirements based on a person’s
sex, age, ancestry, color, disability, ethnicity, gender identity,
genetic information, marital status, national origin, race, religion,
sex, or sexual orientation.
COMMITTEE ACTION
Human Services Committee
Joint Favorable
Yea 15 Nay 8 (03/19/2026)