Substitute House Bill No. 5483 seeks to expand Medicaid coverage to include fertility care services, effective January 1, 2027. The bill introduces new definitions for terms such as "fertility diagnostic care," "infertility," "intrauterine insemination," and "in-vitro fertilization" (IVF). It mandates that the Commissioner of Social Services provide coverage for fertility diagnostic care, standard fertility preservation services, and infertility treatment, while prohibiting any waiting periods or restrictions based on prior diagnoses, disabilities, or the use of donor gametes. This ensures equitable access to fertility services regardless of age, gender identity, or other personal characteristics.

Furthermore, the bill requires the Commissioner to consult with the Centers for Medicare and Medicaid Services to classify IVF as a medically necessary procedure for Medicaid coverage. A report detailing potential methods for covering IVF and the associated funding requirements must be submitted to the Human Services Committee by July 1, 2027. The estimated fiscal impact includes a cost of at least $200,000 for FY 27 and between $500,000 to $5.2 million for FY 28, reflecting the anticipated expenses for fertility treatments and related services. Currently, Medicaid does not cover infertility treatment, but this bill aims to change that by outlining necessary treatments and services that must be included in coverage.