Coverage for in vitro fertilization and genetic testing.

  1. Law
  2. Utah Code
  3. Utah Health Code
  4. Medical Assistance Act
  5. Medicaid Waiver
  6. Coverage for in vitro fertilization and genetic testing.

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Affected by 63I-2-226 on 7/1/2030

Effective 5/12/2020
26-18-420. Coverage for in vitro fertilization and genetic testing.
  • (1) As used in this section:
    • (a) "Qualified condition" means:
      • (i) cystic fibrosis;
      • (ii) spinal muscular atrophy;
      • (iii) Morquio Syndrome;
      • (iv) myotonic dystrophy; or
      • (v) sickle cell anemia.
    • (b) "Qualified enrollee" means an individual who:
      • (i) is enrolled in the Medicaid program;
      • (ii) has been diagnosed by a physician as having a genetic trait associated with a qualified condition; and
      • (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual.
  • (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state plan amendment with the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services to implement the coverage described in Subsection (3).
  • (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for:
    • (a) in vitro fertilization services; and
    • (b) genetic testing of a qualified enrollee who receives in vitro fertilization services under Subsection (3)(a).
  • (4) The Medicaid program may not provide the coverage described in Subsection (3) before the later of:
    • (a) the day on which the waiver described in Subsection (2) is approved; and
    • (b) January 1, 2021.
  • (5) Before November 1, 2022, and before November 1 of every third year thereafter, the department shall:
    • (a) calculate the change in state spending attributable to the coverage under this section; and
    • (b) report the amount described in Subsection (4)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.




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