COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
Christina Henderson Committee Member
Councilmember, At-Large Government Operations and Facilities
Health
Labor and Workforce Development
Transportation and the Environment
Statement of Introduction
Expanding Access to Fertility Treatment Amendment Act of 2022
February 28, 2022
Today, I am proud to introduce the Expanding Access to Fertility Treatment Amendment Act of
2022, along with Councilmembers Brianne K. Nadeau, Mary M. Cheh, Anita Bonds, and Charles
Allen. This legislation would expand coverage provided through private insurers, Medicaid and the
DC Healthcare Alliance to include diagnosis and treatment for infertility.
About 11% of women of reproductive age and 9% of men in the United States have experienced
fertility problems, delaying their ability to start families. And yet, the cost of diagnosis and treatment
is inaccessible for many. The average in-vitro fertilization cycle can cost between $20,000 to $25,000.
In the United States, 70% of women who undergo IVF go into debt to cover the cost, which often
causes treatment delays34% of women stopped treatment because of unaffordability.
We know that women without insurance coverage are 3 times more likely to discontinue treatment
after 1 cycle, compared to women with insurance coverage. To combat this unjust and inequitable
access to ones human right, 19 states have passed fertility insurance coverage laws, including
neighboring Maryland and West Virginia.
State mandated coverage has been shown to increase 3-fold the use of infertility services, which is
also linked to better public health outcomes. Additionally, insurance coverage also reduces the
likelihood of births of multiples to one mother, given that the financial pressure to transfer more
than one to two embryos is reduced. This reduces the risk of complications and adverse health
effects for the mother.
In addition to these risks faced by all mothers, Black and brown moms often wade through
infertility silently and do not seek treatments like IVF as frequently as white mothers. Specifically,
according to the CDCs most recent analysis1, 8% of Black women age 25 to 44 seek medical help to
get pregnant, while 15% of white women do so. As mentioned, state mandated coverage is proved
to increase utilization of assisted reproductive technologies.
This bill would mandate private insurers, Medicaid, and the DC Healthcare Alliance to offer
coverage for diagnosis and treatment of infertility. This legislation explicitly prohibits health insurers
from:
1Center for Disease Control and Prevention, Infertility Service Use in the United States: Data From the National Survey of Family Growth, 1982
2010 2014. www.cdc.gov/nchs/data/nhsr/nhsr073.pdf
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 COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, nw
Washington, D.C. 20004
Imposing additional costs, waiting periods, or other limitations on converge for the diagnosis
of infertility;
Placing pre-existing condition exclusions or waiting periods on coverage for the treatment of
infertility, or using prior treatment for infertility as a basis for excluding, limiting or
otherwise restricting coverage; and
Limiting on coverage for fertility treatment based on a class protected under the Human
Rights Act.
I look forward to working with my colleagues to enhance coverage offered for future mothers and
families in the District.
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2 Councilmember Brianne K. Nadeau Councilmember Christina Henderson
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6 Councilmember Anita Bonds Councilmember Mary M. Cheh
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10 Councilmember Charles Allen
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18 AN ACT
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20 ______________
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22 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
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26 To amend the Womens Health and Cancer Rights Federal Law Conformity Act of 2000 to
27 require an individual health plan, group plan, or health insurer offering health insurance
28 coverage through Medicaid and the D.C. Healthcare Alliance program to provide
29 coverage for the diagnosis and treatment of infertility.
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31 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
32 act may be cited as the Expanding Access to Fertility Treatment Amendment Act of 2022.
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34 Sec. 2. The Womens Health and Cancer Rights Federal Law Conformity Act of 2000,
35 effective April 3, 2001 (D.C. Law 13-254; D.C. Official Code 31-3831 et seq.) is amended to
36 add a new section 5f to read as follows:
37 Sec. 5f. Coverage of Fertility Treatments.
38 (a)(1) Beginning January 1, 2023, an individual health plan, group health plan, health
39 insurer, and a health insurer offering health insurance coverage through Medicaid and the D.C.
40 Healthcare Alliance program shall provide coverage for the diagnosis and treatment of infertility,
41 including in vitro fertilization.
42 (2) Every insurer shall communicate the availability of coverage to all
43 policyholders and to all prospective group policyholders with whom they are negotiating.
44 (b) Coverage for the treatment of infertility shall be provided without discrimination on
45 the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender
46 identity, genetic information, marital status, national origin, race, religion, sex, or sexual
47 orientation.
48 (c) A health insurer shall not impose:
49 (1) Deductibles, copayments, coinsurance, benefit maximums, waiting
50 periods or any other limitations on coverage for the diagnosis and treatment of infertility,
51 including the prescription of fertility medications, different from those imposed upon benefits for
52 services not related to infertility;
53 (2) Pre-existing condition exclusions or pre-existing condition waiting periods
54 on coverage for the diagnosis and treatment of infertility or use any prior diagnosis of or prior
55 treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability
56 of coverage for required benefits; or
57 (3) Limitations on coverage based solely on arbitrary factors including, but not
58 limited to, number of attempts, dollar amounts, age, or provide different benefits to, or impose
59 different requirements upon a class protected under the Human Rights Act of 1977, effective
60 December 13, 1977 (D.C. Law 2-38; D.C. Official Code 2-1401.01 et seq.) than that provided
61 to, or required of, other patients.
62 (d) Nothing in this section shall be construed to interfere with the clinical judgment of a
63 physician and surgeon.
64 (e)(1) A health insurer offering health insurance coverage to an employer organized and
65 operating as a nonprofit entity and referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal
66 Revenue Code of 1986, approved October 22, 1986 (100 Stat. 2740; 26 U.S.C.
67 6033(a)(3)(A)(i) or (iii)) may issue a health insurance policy that excludes coverage for methods
68 of diagnosis and treatment of infertility that are contrary to the employers bona fide religious
69 tenets.
70 (2) Any health insurance policy issued pursuant to this subsection shall provide
71 written notice to each insured or prospective insured that methods of diagnosis and treatment of
72 infertility are excluded from the policy coverage.
73 (f) For the purposes of this section, the term:
74 (1) Infertility means the condition of an individual who is unable to conceive
75 or produce conception or sustain a successful pregnancy during a one-year period or such
76 treatment is medically necessary.
77 (2) Treatment for infertility means procedures consistent with established
78 medical practices in the treatment of infertility by licensed physicians and surgeons, including,
79 but not limited to, diagnosis, diagnostic tests, medication, surgery, and gamete intrafallopian
80 transfer.
81 Sec. 3. Fiscal impact statement.
82 The Council adopts the fiscal impact statement in the committee report as the fiscal
83 impact statement required by section 4a of the General Legislative Procedures Act of 1975,
84 approved October 16, 2006 (120 Stat. 2038; D.C. Official Code 1-301.47a).
85 Sec. 4. Effective date.
86 This act shall take effect following approval by the Mayor (or in the event of veto by the
87 Mayor, action by the Council to override the veto), a 30-day period of congressional review as
88 provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December
89 24, 1973 (87 Stat. 813; D.C. Official Code 1-206.02(c)(1)), and publication in the District of
90 Columbia Register.