ASSEMBLY APPROPRIATIONS COMMITTEE

STATEMENT TO

ASSEMBLY, No. 5383

STATE OF NEW JERSEY

DATED:  JUNE 19, 2025

      The Assembly Appropriations Committee reports favorably and with committee amendments Assembly Bill No. 5383.

      As amended and reported, 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 amended 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, as amended, 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 aged 35 through 44 years of age, and specifies that nothing in this definition may be used to deny or delay treatment to an individual on the basis of relationship status or sexual orientation. 

      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 whether 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.

COMMITTEE AMENDMENTS:

      The committee amendments specify that nothing in the definition of “infertility” shall be used to deny or delay treatment to an individual on the basis of relationship status or sexual orientation.

FISCAL IMAPCT:

      The Office of Legislative Services (OLS) concludes that NJ FamilyCare costs will increase by an indeterminate amount to cover up to three rounds of medically necessary ovulation enhancing medications and certain medical services related to prescribing and monitoring the use of such drugs for NJ FamilyCare enrollees, ages 21 through 44 years, who are experiencing infertility.  The medications and medical services covered under the bill are the same as those provided by the New York Medicaid program.  Given that approximately 95 percent of NJ FamilyCare beneficiaries are enrolled on one of the five State-contracted NJ FamilyCare managed care organizations (MCOs), and the reimbursement rates paid by the MCOs are proprietary, the OLS cannot determine with certainty the amount by which NJ FamilyCare costs would increase under the bill.  To the extent that State Medicaid expenditures increase under the bill, State revenues will increase in the form of federal Medicaid reimbursements.

      For context, in FY 2018, the first full year in which the New York Medicaid program covered ovulation enhancing medications and related medical services, the state estimated that federal Medicaid costs for the new benefit would total $45,000, suggesting that total state and federal costs would approximate $90,000 in FFY 2018. The New York benefit covers four specific ovulation enhancing medications; by contrast, A5383 does not specify which ovulation enhancing medications would be covered under the bill.  While list prices for generic versions of oral ovulation enhancing medications can be under $100 per month, list prices for hormonal injections to stimulate ovulation can reach thousands of dollars per cycle.