HB 589: Social services; coverage for fertility diagnostic care, treatment, and preservation services; provide

Georgia Medicaid currently does not guarantee coverage for infertility diagnosis or treatment. This bill would add a new section to Georgia law (O.C.G.A. § 49-4-159.5) requiring the Department of Community Health to amend the Georgia Medicaid plan so it covers fertility diagnostic care, fertility treatment, and fertility preservation services for people defined as fertility patients, including those with infertility, those lacking necessary sperm or eggs to conceive, and couples at increased risk of passing on a serious genetic condition to a child. The coverage would need to include at least three complete egg retrievals with unlimited embryo transfers, coverage regardless of whether donor gametes or a third-party's uterus is used, and at least three cycles of ovulation-enhancing medication. It would not require coverage of experimental procedures or nonmedical costs tied to donor gametes, embryos, or surrogacy. The Department must report to the General Assembly by August 1, 2026 on covering IVF as a Medicaid benefit, and may need to seek a federal plan amendment or waiver. It would take effect when signed by the Governor and apply to plans issued or renewed on or after January 1, 2026.

• Adds a new Georgia law requiring the Department of Community Health to amend the Georgia Medicaid plan to cover fertility diagnostic care, fertility treatment, and fertility preservation services beginning January 1, 2026.
• Requires coverage of at least three complete egg retrievals with unlimited embryo transfers from those retrievals, using single embryo transfer when medically appropriate.
• Requires coverage of at least three cycles of ovulation-enhancing medication and related monitoring, plus intrauterine insemination intended to achieve a live birth.
• Bars discrimination in coverage based on race, religion, national origin, sex, sexual orientation, gender, or disability, and allows coverage even when donor gametes, donor embryos, or a third-party uterus are used.
• Excludes coverage for experimental fertility procedures and nonmedical costs related to donor gametes, donor embryos, or surrogacy.
• Directs the Department of Community Health to report to the General Assembly by August 1, 2026 on options for covering in-vitro fertilization as a Medicaid benefit and to seek any needed federal plan amendment or waiver.

Georgia Medicaid recipients who experience infertility or who face medical treatment that could impair their fertility, including couples at risk of passing on serious genetic conditions. The Department of Community Health, which administers Medicaid, and its managed care organizations would also be directly affected by the new coverage mandate.

For Georgians on Medicaid, this could mean access to fertility diagnosis, treatment such as egg retrieval and embryo transfer, and fertility preservation before cancer treatment or other fertility-threatening care, services that are not consistently covered today. It would also require state agencies to seek federal approval and report on IVF coverage costs.

• Section 1 creates O.C.G.A. § 49-4-159.5, defining terms such as 'fertility patient,' 'infertility,' 'fertility preservation services,' and 'experimental fertility procedure.'
• Subsection (b) requires the Department of Community Health to amend the Georgia Medicaid plan by January 1, 2026 to cover fertility diagnostic care, fertility treatment, and fertility preservation services.
• Subsection (c) sets a minimum coverage floor of three complete egg retrievals with unlimited embryo transfers, following American Society for Reproductive Medicine guidelines.
• Subsection (g) excludes coverage for experimental fertility procedures and nonmedical costs tied to donor gametes, embryos, or surrogacy.
• Subsection (h) requires coverage of ovulation-enhancing drugs, monitoring, and intrauterine insemination, including at least three cycles of ovulation-enhancing medication per Medicaid eligibility period.
• Subsection (i) requires a report to the General Assembly by August 1, 2026 on covering IVF and fertility preservation as a Medicaid benefit, including funding needs.
• Subsection (j) directs the Department to seek a Medicaid plan amendment or federal waiver when needed to implement the section.
• Section 2 sets the effective date as upon the Governor's approval, applying to plans issued or renewed on or after January 1, 2026.

1. 2025-02-26House Second Readers (Cámara de Representantes)
2. 2025-02-24House First Readers (Cámara de Representantes)
3. 2025-02-21House Hopper (Cámara de Representantes)

• Karla Drenner (D, HD-085)Patrocinador principal
• Park Cannon (D, HD-058)
• Michelle Au (D, HD-050)
• Samuel Park (D, HD-107)

• Medicaid coverage
• fertility treatment
• infertility care
• IVF
• health insurance mandates