Substitute House Bill No. 7022 mandates the Commissioner of Social Services to amend the Medicaid state plan to include coverage for fertility diagnostic care, preservation services, and treatment. This includes coverage for medically necessary ovulation-enhancing drugs and a minimum of three cycles of related medication treatment. The bill defines "infertility" based on various medical conditions affecting conception, such as the inability to achieve pregnancy after six months of unprotected intercourse and age-related factors. It also requires that fertility preservation services be provided to individuals with medical conditions or those undergoing treatments that may impair fertility, including the procurement and cryopreservation of gametes and embryos, with a storage requirement of at least five years or until the individual reaches age 30.

Furthermore, the bill requires the Commissioner to consult with the Centers for Medicare and Medicaid Services by July 1, 2026, to report on the costs and benefits of including in-vitro fertilization (IVF) as a covered benefit under Medicaid, addressing potential Medicaid waivers and financial implications for the state. The legislation is set to take effect on January 1, 2026, with estimated costs for the Department of Social Services of at least $200,000 in FY 26 and between $500,000 to $5.2 million in FY 27. The bill emphasizes that all services must align with established medical practices and guidelines from the American Society of Reproductive Medicine or comparable organizations, ensuring that medically necessary fertility assistance is accessible within the Medicaid framework.