The proposed bill amends the Rhode Island Medicaid Reform Act of 2008 by introducing a new section that mandates Medicaid coverage for various fertility-related services beginning January 1, 2027. This includes coverage for fertility diagnostic care, standard fertility preservation services, medically necessary ovulation-enhancing medications, and intrauterine insemination.

The bill defines key terms such as "fertility diagnostic care," which encompasses counseling, products, medications, procedures, genetic testing, and services intended to provide information about an individual's fertility; "infertility," which includes conditions affecting the ability to establish or carry a pregnancy; and "intrauterine insemination," a procedure that places sperm directly into an individual's uterus to increase the chances of fertilization.

Coverage will include standard fertility preservation services, which may involve the storage of reproductive materials until the individual reaches the age of thirty or for five years, whichever is longer. The bill specifies that coverage must include at least three cycles of ovulation-enhancing medication treatment and at least six cycles of intrauterine insemination. If ovulation-enhancing medication treatment is administered with the intention of preparing for intrauterine insemination but results in a counter-indicated response, coverage for in vitro fertilization (IVF) and embryo transfer will be provided as recommended by the treating physician.

The bill prohibits coverage from imposing waiting periods or restrictions based on prior diagnoses, disabilities, or the use of donor gametes. It also ensures that different limitations on coverage cannot be imposed based on demographic factors such as age, ancestry, color, disability, ethnicity, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.

Additionally, the Department of Health and Human Services is required to submit a report by January 1, 2027, to the speaker of the house and president of the senate, after consulting with the Centers for Medicare & Medicaid Services, regarding the medical necessity of IVF under federal law, potential methods for covering IVF as a Medicaid benefit, and the funding required for such coverage. The provisions of this section will apply to Medicaid state plans issued or renewed on or after January 1, 2027.