ASSEMBLY APPROPRIATIONS COMMITTEE

STATEMENT TO

[First Reprint]

ASSEMBLY, No. 1207

STATE OF NEW JERSEY

DATED:  JUNE 23, 2026

      The Assembly Appropriations Committee reports favorably Assembly Bill No. 1207 (1R).

      This bill requires Medicaid coverage for ovulation enhancing drugs and the medical services related to administering such drugs for certain beneficiaries who are experiencing infertility.

      Specifically, the amended bill mandates that Medicaid is to provide coverage for expenses incurred in the provision of medically necessary ovulation enhancing drugs, including the oral versions of clomiphene, bromocriptine, letrozole, tamoxifen, and any other oral ovulation enhancing drug for which the Division of Medical Assistance and Health Services (DMAHS) receives federal financial participation to provide, and the medical services related to prescribing and monitoring the use of such drugs for individuals 21 through 44 years of age who are experiencing infertility, provided that all necessary federal approvals are secured and federal financial participation available is available for State expenditures under the federal Medicaid program.

      As defined under the bill, “infertility” means a condition characterized by the incapacity to conceive, as defined by either:  the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse for individuals 21 through 34 years of age; or the failure to establish a clinical pregnancy after six months of regular, unprotected sexual intercourse for individuals 35 through 44 years of age.

      The bill mandates that medical services covered under the bill are limited to office visits, hysterosalpingograms, pelvic ultrasounds, and blood testing to diagnose the cause of anovulation or to monitor ovulation induction.  Moreover, coverage of ovulation enhancing drugs and medical services under the bill is limited to three cycles of treatment per lifetime of the beneficiary.

FISCAL IMPACT:

      The Office of Legislative Services (OLS) determines that annual NJ FamilyCare costs will increase by an indeterminate amount to cover up to three rounds of certain oral versions 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.  Given that approximately 95 percent of NJ FamilyCare beneficiaries are enrolled on of the five State-contracted NJ FamilyCare managed care plans, and the State’s contract with the NJ FamilyCare managed care organizations specifically precludes coverage for services provided primarily for the diagnosis and treatment of infertility, 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.