LEGISLATIVE FISCAL ESTIMATE
ASSEMBLY, No. 4601
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: JUNE 28, 2024
SUMMARY
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Synopsis: |
Requires health insurance and Medicaid coverage for reproductive health care services; prohibits adverse actions by medical malpractice insurers in relation to performance of health care services. |
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Type of Impact: |
Annual State and local government expenditure increases. |
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Agencies Affected: |
Department of the Treasury; Department of Human Services. |
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Office of Legislative Services Estimate |
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Fiscal Impact |
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Annual |
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State Expenditure Increase for NJ FamilyCare |
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At least $2.9 million |
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State Expenditure Increase for SHBP/SEHBP |
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De Minimis |
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Local Expenditure for SHBP/SEHBP |
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De Minimis |
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· The Office of Legislative Services (OLS) estimates that requiring the State Medicaid program, also known as NJ FamilyCare, to provide coverage for abortion services without cost sharing will result in annual State expenditure increases of at least $2.9 million.
· The OLS anticipates that requiring the State Health Benefits Program and the School Employees’ Health Benefits Program to provide coverage for abortion services without cost sharing will increase costs to the State and participating local governments by a maximum of $210 per procedure. The OLS does not have the information to determine the number of procedures provided under the State Health Benefits Program and the School Employees’ Health Benefits programs, but anticipates that increase will have a de minimis impact on program costs.
BILL DESCRIPTION
This bill requires all hospital and medical benefits contracts offered in this State, including those providing for the administration of health benefits in connection with the State Health Benefits Program and School Employees’ Health Benefits Program, and the NJ FamilyCare/Medicaid program, to provide coverage for abortion without cost sharing.
The bill also prohibits medical malpractice insurers from taking adverse action against insureds for the provision or facilitation of reproductive health care services or gender-affirming health care if the adverse action rests solely on the fact that the patient receiving the service is a resident of a state where providing or facilitating the service is illegal.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that requiring the State Medicaid program, also known as NJ FamilyCare, to provide coverage for abortion services without cost sharing will result in annual State expenditure increases of at least $2.9 million. Under current law, the State Medicaid program is permitted to cover abortions for enrollees with the use of State funds only when the abortion is medically necessary, which limits utilization of the procedure. As a result, the OLS anticipates that the primary cost impact to the State under the bill will occur via increased utilization of abortion care services provided through the NJ FamilyCare program.
No federal Medicaid reimbursements are available for abortion services because of the prohibitions on the use of federal funds for abortion under the Hyde Amendment. As such, the State would bear the entire fiscal impact.
The OLS anticipates that requiring the State Health Benefits Program and the School Employees’ Health Benefits Program to provide coverage for abortion services without cost sharing will increase costs to the State and participating local governments by a maximum of $210 per procedure. Currently, both programs cover the cost of in-network elective abortions at 100 percent after a $30 copay. Out-of-network care is covered at 70 percent and the out-of-network deductible is applied to the covered person’s cost share. The OLS does not have the information to determine the number of procedures covered by the State Health Benefits Program and School Employees’ Health Benefits Program annually, but concludes that the overall cost increase to the programs will be de minimis. Accordingly, the cost increase to the State and participating local governments due to program expenditures is also expected to be de minimis.
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Section: |
State Government |
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Analyst: |
Assistant Fiscal Analyst |
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Approved: |
Thomas Koenig Legislative Budget and Finance Officer |
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).