Does Medicaid Cover IVF in Maryland?
Learn how Maryland Medicaid covers IVF, including eligibility, covered treatments, and the process for accessing fertility services.
In Vitro Fertilization (IVF) is a medical procedure where eggs are fertilized by sperm in a laboratory, creating embryos for transfer to the uterus. Medicaid, a joint federal and state program, provides healthcare coverage to millions of low-income individuals and families across the United States. This article explores how Maryland’s Medicaid program addresses coverage for fertility-related services, particularly focusing on IVF.
Maryland Medicaid Coverage for Infertility Treatment
Maryland Medicaid does not generally cover In Vitro Fertilization (IVF) for common infertility. However, it does cover fertility preservation services. As of October 7, 2023, the Maryland Medical Assistance Program expanded its benefits to include these services, mandated by House Bill 908. This coverage applies to “iatrogenic infertility,” which is fertility impairment caused by medical treatment or intervention. Such treatments include surgery, radiation, chemotherapy, or gender-affirming therapies that may affect reproductive organs or processes. While general infertility treatment, including IVF for conception, remains largely outside of standard Medicaid benefits in Maryland, services aimed at preserving fertility prior to medical procedures that could cause permanent infertility are covered.
Eligibility for Fertility Preservation Coverage
To be eligible for fertility preservation services, individuals must first meet general Maryland Medicaid enrollment criteria, including income thresholds, Maryland residency, and U.S. citizenship or qualified non-citizen status. Eligibility for full Medicaid coverage ensures access to the broader range of medical benefits, including the newly expanded fertility preservation services.
Beyond general enrollment, specific medical and demographic criteria apply. Services must be medically necessary to preserve fertility due to a medical treatment that may cause iatrogenic infertility, such as cancer or gender-affirming care.
Individuals must be within reproductive age, generally defined as from puberty through menopause. Minors require parental or guardian consent.
The treating provider must be a Reproductive Endocrinologist, a specialist in reproductive medicine. Documentation confirming the diagnosis of iatrogenic infertility and the necessity of the preservation services is a prerequisite for coverage.
Covered Fertility Preservation Services and Limitations
Maryland Medicaid’s fertility preservation coverage encompasses a range of specific medical services and related procedures. Covered services include an initial fertility preservation consultation, along with necessary laboratory assessments, medications, and other medically necessary treatments.
Specific procedures such as ovulation induction, monitoring, and oocyte retrieval are covered when performed for the purpose of oocyte preservation. Additionally, oocyte cryopreservation and evaluation, ovarian tissue cryopreservation and evaluation, and sperm extraction, cryopreservation, and evaluation are included. Gonadal suppression using GnRH analogs, a treatment to protect reproductive organs during certain medical therapies, is also covered.
A significant limitation is that cryopreservation of ovarian tissue and sperm is generally a one-time benefit. The program covers a maximum of three cycles of ovarian stimulation and oocyte preservation.
Certain services are explicitly not covered within this preservation benefit. These exclusions include the actual In Vitro Fertilization (IVF) procedure for conception, donor sperm, and donor oocytes. Long-term storage of cryopreserved sperm or oocytes, beyond the initial cryopreservation, is typically not covered. Medications must be approved by the Food and Drug Administration (FDA) and qualify under the Federal Rebate Program for coverage.
Accessing Fertility Preservation Treatment through Maryland Medicaid
Individuals who meet the eligibility criteria and require fertility preservation services through Maryland Medicaid must navigate a specific procedural pathway. A primary step involves obtaining prior authorization for these services.
The healthcare provider, typically a Reproductive Endocrinologist, is responsible for submitting comprehensive documentation to the Maryland Medical Assistance Program. This documentation must include clinical notes supporting the diagnosis of iatrogenic infertility and a detailed treatment plan for the proposed fertility preservation services.
Once approved, prior authorizations for fertility preservation procedures are generally valid for a period of three months. It is important for individuals to confirm that their chosen fertility specialist and facility are part of the Maryland Medicaid provider network.