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DC Law Expands Health Insurance Coverage to Include Fertility Diagnosis, Treatment

The Expanding Access to Fertility Treatment Amendment Act, as proposed by at-large council member Christina Henderson, to address fertility coverage issues across the District.

The U.S. and D.C. flags flow harmoniously during the momentous change in D.C.’s healthcare system to expand coverage regarding fertility and treatment for women. (Natalia Wilson/The Hilltop)

Washington D.C. passed a law to expand healthcare coverage to include fertility diagnosis screenings and treatment for women who reside in the city earlier this month. The Expanding Access to Fertility Treatment Amendment Act of 2023 was proposed by Christina Henderson, the District’s at-large council member and health committee chair. 

As women across the city experience varying and unequal access to fertility and maternal health resources, Henderson became inspired to create the bill, which just passed congressional review, after a conversation with a friend who experienced infertility.

This friend was Maya Martin Cadogan, who had to choose between purchasing her family home or undergoing expensive in vitro fertilization (IVF) treatment.

“That is when I started to do a bit more investigation around what this really means for families from an expense standpoint, but also what other jurisdictions offered fertility coverage as part of the requirements that they have for health insurance companies,” Henderson told The Hilltop.

According to Forbes, a single round of IVF can cost between $15,000 – $30,000, excluding related expenses like medication, screenings, subsequent retrievals and embryo transfers should a single round be unsuccessful. As a result, many individuals are faced with costs upwards of six figures.

Today, 22 states have fertility insurance coverage laws according to RESOLVE: The National Infertility Association, which was established in 1974 and seeks to increase awareness of family-building options. Only 15 states include coverage for IVF and 17 states mandate fertility preservation coverage for medically induced infertility.

“Infertility is a medical diagnosis and therefore your health insurance should cover it,” Henderson said. 

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Henderson and her committee soon learned that the Cardogan’s story was similar to that of many D.C. families. When speaking to people in local communities, Henderson heard from several individuals who left jobs in D.C. for jobs based in Maryland because of the health insurance coverage that would enable them to expand their families without severe financial stress.

“With everything going on at the Supreme Court, it is important that local and state governments are championing the rights, well-being and health of Black women,” a sophomore political science and sociology major from Houston, Texas, Jitey Ikuku said. 

Ikuku emphasized the necessity for seemingly small, yet impactful changes to improve women’s livelihoods step by step. 

“It is inspiring to see women in these positions make [other] women’s lives easier,” Ikuku said. 

The first version of the Expanding Access to Fertility Treatment Amendment Act was proposed in 2022 and the legislation came to fruition despite obstacles during the initial review. 

In January 2023, Henderson reintroduced the bill, also known as B25-0034. After major revisions, the new bill has several important features such as mandatory coverage of fertility preservation for individuals undergoing treatment that could reduce fertility, like chemotherapy.  Insurers are also required to cover three IVF cycles, including egg retrieval. The coverage also extends to unlimited embryo transfers and third parties, meaning full coverage for those who use a surrogate to carry. 

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When the bill was originally proposed, it fully covered fertility treatments and services for all Medicaid and Alliance recipients. Henderson and the city council’s Health Committee adjusted the bill to only cover diagnosis and medication since the Centers for Medicare & Medicaid Services (CMS) did not recognize infertility as a reimbursable medical issue. 

In doing so, the council ensured that the bill would offer a sufficient level of coverage to Medicaid recipients within the bounds of federal government restrictions. 

“The most challenging thing was trying to be as inclusive as possible,” Henderson said.

“Inclusivity not just from a socioeconomic standpoint, but we also were very intentional about making sure that LGBTQIA+ individuals could also participate as well.” 

While research has shown that disparities exist, Black and Indigenous women experience infertility at a higher rate than white women especially considering socioeconomic and risk factors such as fibroids and PCOS. Moreover, one in every eight women suffers from infertility, which affects Black women disproportionately according to Progyny, a public company that provides coverage for fertility and family-building services. 

According to Henderson, Black women are far less likely to access fertility diagnosis and treatment due to economic barriers. 

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The at-large council member admitted that she was shocked to learn that states that have mandated healthcare coverage of fertility diagnosis and treatment defined the policy in terms of heterosexual couples and married couples. 

“A lot of people when they think of IVF, for whatever reason, the picture that it evokes in their head is of a wealthy white woman who is going through this process,” Henderson said. 

Thus, the bill also worked to address the needs of Black and brown people experiencing infertility. “What people don’t realize is that Black and brown women actually have higher incidences of infertility, but are less likely to seek treatment because we cannot afford to do so,” Henderson said. 

“So, by having health insurance cover it as part of the monthly premium that you already pay, this in some way hopes to level the playing field for individuals who wanted to seek this as an option but financially just couldn’t manage the cost,” she continued. “Our hope is that this bill helps folks not have to live with this burden alone and have no way to try to rectify [infertility] if they wanted to.”

The Expanding Access to Fertility Treatment Amendment Act of 2023 garnered the support of Howard University students, inspired by Henderson’s persistence in getting the law passed and funded.

Mia Kamara, a junior health science major and chemistry minor from Woodbridge, Virginia, by way of Sierra Leone at Howard University, hopes that this law helps to establish a national standard for healthcare coverage.

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“It is a basic human right to have children if you ever so desire, so I think this bill is a great start towards making change in women’s healthcare,” Kamara said. “I just hope with these new health policies that they expand and become a nationwide, not just local change.”

Copy edited by Alana Matthew


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