The bill amends the Rhode Island Medicaid Reform Act of 2008 by introducing a new section, 42-12.4-10, which 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.

Key definitions are provided, including "fertility diagnostic care," which encompasses counseling, products, medications, procedures, genetic testing, and services aimed at assessing an individual's fertility. "Infertility" is defined in three ways, including the inability to establish a pregnancy after twelve months of unprotected intercourse. "Intrauterine insemination" is defined as a procedure that places sperm directly into an individual's uterus to enhance the chances of fertilization.

The bill specifies that coverage must include storage of gametes and embryos until the individual reaches the age of thirty or for five years, whichever is longer. It also requires coverage for at least three cycles of ovulation-enhancing medication treatment and at least six cycles of intrauterine insemination. If ovulation-enhancing medication treatment does not lead to intrauterine insemination due to an ovulation response, coverage for in vitro fertilization (IVF) and embryo transfer is mandated as recommended by the treating physician.

Additionally, 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 no different limitations on coverage are 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.

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.