More state lawmakers seek to mandate IVF insurance coverage, but threats abound

In-vitro fertilization (IVF) is widely popular among Americans, and an increasingly coveted workplace benefit.

Nevertheless, legislation threatening access to these family-building procedures has picked up in the years since the Supreme Court overturned the federal right to an abortion in Dobbs v. Jackson Women’s Health Organization. One major threat to IVF occurred in 2024 when the Alabama Supreme Court ruled embryos should be considered children, prompting many clinics to temporarily pause services.

While Alabama legislators ultimately passed a law to shield IVF clinics from legal liability, other states have since considered bills that would grant personhood to embryos. Such bills have been introduced repeatedly in South Carolina, though they haven’t passed.

“There is an increasingly—while they’re still small—loud and organized and well-funded anti-IVF movement, and they’re trying to find creative ways to target access,” Danielle Melfi, CEO of RESOLVE, the national infertility and family-building association, told HR Brew.

US lawmakers introduced 181 bills related to fertility during the 2026 legislative session, 30 of which posed a potential risk to IVF access, according to a recent report from RESOLVE. While this is lower than the 2025 legislative session—when lawmakers considered 258 fertility-related bills, 58 of which were deemed to potentially threaten IVF access—it nevertheless highlights a still-present challenge for patients seeking to build their families this way.

Insurance mandates gain ground. On balance, RESOLVE has tracked more bills seeking to expand IVF access than limit it, Melfi noted.

Proposals to mandate that insurers cover fertility treatments are gaining ground as one lever to enable access. Legislators in five states—Michigan, Minnesota, Oregon, Pennsylvania, and Wisconsin—introduced such mandates this year, the RESOLVE report found, though none have passed yet. And Virginia passed a law that will add fertility services to its benchmark Essential Health Benefits plan, which details services that individual and small-group health plans must cover under the Affordable Care Act. The change is pending approval by the Centers for Medicare and Medicaid Services.

Conversations about insurance mandates in state legislatures this year ultimately came down to cost, Melfi said. She observed that “the trickle down of action at the federal level was squeezing state budgets in a way that legislatures were increasingly cost conscious,” pointing to cuts to federally funded programs such as Medicaid.

It’s worth noting that state statutes mandating that health plans cover IVF exclude self-funded health plans, HR Brew reported last year. Any move to significantly lower costs of the treatment or boost employer-sponsored coverage would likely require a more broad-sweeping mandate by Congress, one policy expert told us.

Thus far, the Trump administration has taken action to lower the costs of some fertility medications, as well as endorsed a less burdensome approach for employers to cover the treatments as a standalone benefit, akin to the way dental or vision is offered. The White House has stopped short of pushing for a federal IVF insurance mandate, however.

As of 2024, 47% of large employers covered IVF services in their largest medical plan, according to the most recent data from consulting firm Mercer, up from 22% in 2019.