California's much-moved IVF law may be delayed until 2026, leaving many in the lurch

California's much-moved IVF law may be delayed until 2026, leaving many in the lurch

California lawmakers are poised to delay the state's much-anticipated new law enforcing in vitro fertilization insurance for millions, set to take effect July 1. Gov. Gavin Newsom has asked lawmakers to push the implementation date forward to the 2026 implementation date, leaving patients, insurers and employers in limbo.

The law, SB 729, requires federally regulated health plans offered by large employers to cover the diagnosis and treatment of infertility, including IVF. Nine million people will qualify for coverage under the law. Supporters have hailed the law as a "major victory for Californians," particularly in helping same-sex couples and aspiring single parents, despite limiting costs across the breadth of the mandate.

People who had planned fertility care based on the original timeline are now "in a holding pattern with more uncertainty, financial strain and emotional distress," said Alise Powell, director at Resolve: The National Inflexility Association, in a statement.

During IVF, a patient's eggs are retrieved, combined with sperm in a laboratory and transferred into a person's uterus. A single cycle can be out of reach for many to the tune of around $25,000. California law requires insurers to cover up to three egg transfers and an unlimited number of embryo transfers.

Not everyone's reporting would be affected by the delay. Even if the law came into effect on July 1, IVF coverage would not have to begin until that month with your insurer. Rachel Arrezola, California Department of Public Health managed health care spokeswoman, said most employers subject to the law renew their contracts in January, so their employees would not be affected by a delay.

She declined to provide data on the percentage of eligible contracts renewed in July or later. This would mean that these participants would not receive IVF coverage until at least a full year in July 2026 or later.

The proposed new implementation date comes amid national attention on fertility coverage. California is now one of 15 states with an IVF mandate, and in February President Donald Trump signed an executive order requesting policy recommendations to expand IVF access.

It's the second time Newsom has asked lawmakers to delay the bill. When the Democratic governor signed the bill in September, he asked lawmakers to consider delaying implementation for six months. The reason, Newsom said, is to allow time to reconcile the differences between the bill and a broader effort by state regulators to include IVF and other fertility services as an essential health benefit, which would require the Marketplace and other individual and small group plans to provide the coverage.

Newsom spokesman Elana Ross said the state needs more time to provide insurer guidance on specific services not addressed in the law to ensure adequate and consistent coverage. Arrezola said embryo storage and donor eggs and sperm were examples of services that require more guidance.

State Sen. Caroline Menjivar, a Democrat who authored the original IVF mandate, acknowledged that a delay could frustrate people who long to expand their families, but "a little longer so we can do this properly."

Sean Tipton, a lobbyist for the American Society for Reproductive Medicine, argued that the few remaining questions about the mandate did not justify a long delay.

Lawmakers appear poised to move forward with delaying a vote by both houses of the Legislature, likely before the end of June. If a delay is approved and signed by the governor, the law would take effect immediately. If that doesn't happen before July 1, Arrezola said, the Department of Health Care Management would enforce the mandate as it exists. All plans had to submit compliance filings to the agency by March. Arrezola could not explain what would happen to IVF patients whose coverage had already begun if the delay was passed after July 1.

The California Association of Health Plans, which opposed the mandate, declined to comment on where implementation efforts stand, although the group agrees insurers need more guidance, spokeswoman Mary Ellen Grant said.

Kaiser Permanente, the state's largest insurer, has already sent employees information about the new benefit to employers, company spokeswoman Kathleen Chambers said. She added that eligible members whose plans were renewed on or after July 1 would have IVF coverage if implementation of the law was not delayed.

Employers and some fertility providers appear to be grappling with the uncertainty of the law's start date. Amy Donovan, an attorney at insurance brokerage and consulting firm Keenan & Associates, said the firm has fielded many questions from employers about the possibility of delays. Reproductive Science Center and Shady Grove Fertility, large clinics that serve various areas of California, noted on their websites that the IVF mandate had been delayed until January 2026, which is not yet the case. They did not respond to requests for comment.

Confused about whether and when they will be covered, some infertility patients are running out of patience. Ana Rios and her wife, who live in the Central Valley, had been trying to have a baby for six years, saving up for each failed treatment. Although she was "damn excited" to learn about the new law last fall, Rios couldn't get clarity from her employer or health plan about whether she was eligible for coverage and when it would take effect, she said. The couple decided to go to Mexico to pursue cheaper treatment options.

“You think you finally have a helping hand,” Rios said of learning about the law and later the requested delay. “They reach out and they take it back.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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