ASSEMBLY HEALTH COMMITTEE

STATEMENT TO

ASSEMBLY, No. 5383

STATE OF NEW JERSEY

DATED:  JUNE 12, 2025

      The Assembly Health Committee reports favorably Assembly Bill No. 5383.

      The bill requires the State Medicaid program to cover ovulation enhancing drugs and the medical services related to administering such drugs for certain beneficiaries who are experiencing infertility.  In doing so, this bill mirrors the infertility benefit provided under Medicaid in New York. 

      Contingent upon the receipt of federal matching funds for State Medicaid expenditures, the bill requires the State Medicaid program to cover expenses for medically necessary ovulation enhancing drugs and the medical services related to prescribing and monitoring the use of such drugs for individuals, aged 21 through 44 years, who are experiencing infertility.  The bill defines “infertility” as the incapacity to conceive after 12 months of unprotected sexual intercourse for individuals aged 21 through 34 years, or after six months of unprotected sexual intercourse for individuals 35 through 44 years of age.

      Medical services covered under the bill are limited to office visits, pelvic ultrasounds, blood testing, and hysterosalpingograms.  A hysterosalpingogram is an x-ray procedure used to determine whether the patient’s fallopian tubes are open and if the inside of the uterus is normal.  Coverage of ovulation enhancing drugs and medical services under the bill is limited to three cycles of treatment over the beneficiary’s lifetime.