Updated 4/12/19

(April 12, 2019) On March 31, 2019, the New York State (NYS) legislature passed the 2020 NYS budget and Governor Cuomo signed the bill into law on April 12, 2019.. The big news is that the Budget includes a change to existing law by requiring that (a) IVF be covered by health insurance provided in the Large Group market, and (b) medically necessary fertility preservation be covered in Large Group, Small Group and Individual markets. This happened because of the hard work of so many advocates, physicians, and partners and a coalition that reached more than 50 organizations. Advocacy wins do not happen overnight. We’re excited to share key details of this significant insurance reform win and what it means to you and #Access2Care.

What does the change to New York insurance law actually do?

The passage of the 2020 New York state Budget includes a major update to existing insurance laws that impact people with infertility, those that struggle to build a family, and cancer patients that want to protect their fertility.

The updated insurance law, which takes effect January 1, 2020, does the following:

  • Provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to people who get their health insurance from a fully-insured employer who has coverage on the Large Group market. These are companies with 100 or more employees.
  • Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility, that is, infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets, including those getting insurance from the Individual market, as well as the fully-insured Small Group and Large Group markets.
  • Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.

After 22 years of fertility nursing I am overjoyed to know my patients will now have the insurance coverage they need to fulfil their dreams and the outpouring of support from the fertility community for this cause was overwhelming. Chris Gray RN, BSN, CNY Fertility Center, Latham, NY

How is this different from the Fair Access to Fertility Treatment Act (FAFTA) and why was this passed in the NY State Budget?

NY Legislature 2018FAFTA, which is a bill RESOLVE and a coalition of organizations have been advocating for, was introduced in the New York Assembly by Aravella Simotas and in the New York Senate by Diane Savino. FAFTA did not limit how many IVF cycles would be covered and FAFTA provided IVF coverage to all commercial plans, including plans in the Individual and Small Group markets.

In early 2019, Governor Cuomo included an IVF proposal in his proposed budget and the New York State Senate included FAFTA in its budget. A three-way budget negotiation took place among the Senate, Assembly and Governor, and the Governor’s proposal was ultimately accepted and approved in the NY State Budget.

Who does the law help?

The law helps people in NY who have health insurance from a NY-based employer that has a fully insured Large Group plan (100+ employees). This is approximately 2.5 million New Yorkers. People covered include:

  • Straight couples who need IVF
  • Lesbian couples who need IVF
  • Single women who need IVF

The law helps anyone who is facing iatrogenic infertility and needs to preserve their sperm or eggs, who is covered by a fully insured Small Group or Large Group plan, or an Individual plan. This includes people who get their insurance through the Exchange (Obamacare). This is approximately 4.7 million New Yorkers. This part of the law only addresses the medical procedures that are “standard fertility preservation procedures” and does not cover an embryo transfer. Standard fertility preservation procedures are not defined in the law.

Finally, I am able to give the state-of-the-art treatment patients so deserve, instead of recommending IVF but having finances preventing my patients from accessing the appropriate care they need. –  James Stelling, MD, Island Fertility, Commack, NY

Who does the law leave out?

The law leaves out anyone who needs IVF and gets their health insurance from a fully-insured Small Group plan (less than 100 employees), is covered by an Individual plan, or anyone who receives their health insurance in New York from the Exchange (Obamacare). For both IVF and Fertility Preservation, the law also leaves out people who are covered by Medicaid in New York, health insurance provided by the Federal government, such as TRICARE and Federal employees, and Veterans. It also leaves out anyone who needs IVF or fertility preservation and receives their health insurance from an employer that is self-insured, which is typically employers that have over 1,000 employees; this is due to federal law, which impacts any insurance law passed in any state. Ask your employer’s HR or benefits staff if your employer is fully-insured or self-insured. If your employer is self-insured, they can choose to cover IVF and fertility preservation. RESOLVE has resources to help you ask for this coverage from your self-insured employer.

Why doesn’t this update to the existing infertility law cover the same things FAFTA covered?

The FAFTA bill included coverage for IVF for everyone in commercial plans in the fully-insured market (Individuals, Small, and Large Group plans.) A little-known provision in the Affordable Care Act (ACA) has made it challenging for states to pass new insurance laws. However, states can update existing insurance laws, which is what the Governor and Legislature did in the NY Budget. The last time the insurance law for infertility treatments was updated in NY was in 2002. Fertility preservation for women didn’t even exist in 2002. Given the unique way the NY law was written in 2002, some deemed FAFTA as a new mandate, which made it very difficult to get coverage for the Individual and Small Group markets (which includes the Exchanges/Obamacare). RESOLVE is helping states identify ways to update their insurance laws within the guidelines of the ACA, and we will continue to seek a solution to the unique issue in NY.

As the Chairperson of the Alliance for Fertility Preservation, I’m so pleased to see that these patients recently diagnosed with a life-threatening but treatable disease are not having to make a choice between staying alive or having a family. It’s a true victory for our patients and I can say that I am truly proud to be a New Yorker. -Glenn Schattman, MD, Weill Cornell Medicine, New York, NY

Does this impact the New York State Infertility Demonstration Program?

New York State has offered a grant program for qualifying NY residents who have health insurance that does not cover IVF. This update to the existing NY insurance law does not impact the Infertility Demonstration Program.

New Yorkers who need medical help to build their families – today and in the future – owe a huge debt of gratitude to RESOLVE and its network of supporters who have petitioned for so long to bring logic and fairness to the existing, but outdated, insurance law. – Richard Grazi,MD, GENESIS Fertility, Brooklyn, NY

How we got this done!

Advocacy Day NY 2019Victories like this one do not happen overnight. Advocacy is a marathon, not a sprint, and like a marathon, there are hills and valleys, and people helping you along the way, and even some who get in your way.

In 2016, RESOLVE was able to secure the services of an experienced lobbying firm in Albany, which made a huge difference by having people on the ground representing our interests these past 3+ years.  That year, RESOLVE helped draft legislation to update NY’s current infertility insurance law and formed a coalition of like-minded organizations and companies, including the American Society for Reproductive Medicine (ASRM), Alliance for Fertility Preservation, EMD Serono, and Ferring Pharmaceuticals. The coalition has since grown to more than 50 supporting organizations.

We hosted our first Advocacy Day in Albany in 2016, and every year thereafter. This past February we held our largest NY Advocacy Day with 100 advocates traveling from across the state to meet with their lawmakers. RESOLVE and our coalition partners also made more than a dozen trips to Albany to meet with our bill sponsors, key Committee members, and top officials in Governor Cuomo’s Administration. Because of our communications and grassroots mobilizing strategies, lawmakers received 2,259 letters from their constituents urging them to support FAFTA.

One of the things that, to me, is most powerful about this incredible achievement is the overwhelming majority of those who advocated for this bill will not directly benefit from it. In fact, many who pushed hardest for FAFTA to be passed have reached their family building resolution whether it was through IVF, adoption, surrogacy or even childfree but they went to Albany, contacted their lawmakers, posted on social media, etc. because they want those after them to have the fair shot at having a family that perhaps they, themselves did not. That’s the power and bond of the infertility community. – Jay Palumbo, Blogger, Advocate, New York Resident

As a result, FAFTA passed twice in the Assembly, in 2017 and 2018, and an amended version that we did not support passed the Senate in 2018. The legislative session ended in 2018 before they were able to reconcile the differences in the two bills, so we started over again in the 2019-20 legislative session.

In addition to grassroots advocacy, the Coalition commissioned studies to determine the cost of adding IVF and fertility preservation coverage and to learn what other states have done to update their insurance laws within ACA guidelines.

And last, but not least, we seized every opportunity to shine a spotlight on infertility and the lack of insurance through media interviews and op-eds. By amplifying the voice of the patient, we were able to overcome opposition by much larger, better-funded opponents, such as the NY health insurance plans.

To have our voices truly heard in New York is a remarkable feeling and I’m so grateful to the RESOLVE team for including me in such an empowering community of advocates. – Kienan Robinson, Advocate, New York Resident

Closing Thoughts

Change does not happen overnight, and it does not come without a dedicated community working together towards a common goal–#Access2Care. As you can see from the lists and links below, it took the combined commitment of a coalition of passionate patients and professionals to give New Yorkers a fair shot at family! Now millions more New Yorkers have the peace of mind that if they find themselves struggling to build a family, they are covered. That’s what access is, peace of mind – by removing cost as a barrier to care.

It is hard to keep fighting, year after year, with no success. But I kept telling myself, the only way to ensure that nothing positive happens is to quit. So I kept on working, kept going up to Albany, kept asking my friends and social networks for support, kept contacting supportive legislators and members of the governor’s administration. I had a two-pronged approach: fight for good legislation, and fight for good legislators. This year, we had a confluence of both, and look what happened. I’m so glad we never gave up, and we never will - we will continue to fight to improve this legislation until all New Yorkers, and all Americans, have the much-needed coverage for their diseases. – Risa Levine, RESOLVE Board of Directors, New York Resident

Thank You

Coalition to Help Families Struggling with Infertility – Founding Members in addition to RESOLVE:

  • Alliance for Fertility Preservation
  • American Society for Reproductive Medicine
  • EMD Serono
  • Ferring Pharmaceuticals

The following Professionals and Organizations attended one or more New York Advocacy Days in Albany, NY from 2016-2019, as well as assisted with advocacy efforts in support of FAFTA:

  • A TIME: Brany and Saul Rosen
  • Albany Medical College, Alden March Bioethics Institute: Lisa Campo-Engelstein, PhD
  • Boston IVF – Albany & Syracuse: Steven Bayer, MD; Rick Dietz; Sonia Elguero, MD; Nina Resetkova, MD; Marsha Forman, MSc; Michelle Cioffi, LPN; Renee Bessett; Nicol Cunningham; Sue Gunther; Kathleen Hughes
  • Chelsea Surrogacy Advisors: Susan Baldomar
  • Chick Mission: Amanda Rice; Tracy Weiss
  • CNY Fertility: Robert Kiltz, MD; Niccole Davey, RN; Chris Gray, RN; Justine Taylor, RN; Haley Landers; Desiree Maxon; Joseph Cao
  • Columbia University Medical Center: Monica Bhatia, MD
  • EggFund: Carmela Rea
  • GENESIS Fertility & Reproductive Medicine: Richard Grazi, MD; Donna Palescandolo; Jessica Hance; Dana Joris; Daniela Taliercio; Charlyn Thomas
  • Island Fertility, Stony Brook Medicine: James Stelling, MD
  • Memorial Sloan Kettering Cancer Center: Joanne Kelvin, RN; Rosemary Semler, RN; Lauren Martino, NP; Anne Casson, NP
  • NYU Langone Fertility Center: Liz Fino, MD; Kara Goldman, MD; Susan Maxwell, MD
  • OHEL Children’s Home and Family Services: David Mandel
  • Parenthood for Me: Erica Walther Schlaefer
  • Puah Fertility: Shifra Rosenfeld
  • Reproductive Medicine Associates of Connecticut: Lisa Rosenthal
  • Reproductive Medicine Associates of New York: Christine Briton-Jones, PhD; Rena Stein
  • Reproductive Specialists of New York: James Stelling, MD
  • Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (CRM) of Weill Cornell Medicine: Glenn Schattman, MD; Alessia Daniele; Daniel Pollay; Bridget Wahmann; Justine Witzke
  • Suffolk County Acupuncture: James Vitale

In addition to the medical practices listed above, the following practices assisted the Coalition in multiple ways by advocating for FAFTA:

  • Kofinas Fertility Group
  • Long Island IVF
  • Northwell Health Fertility

The organizations below joined the Coalition and/or sent a letter of support:

  • American College of Obstetricians and Gynecologists (ACOG), District II
  • Association for Mental Health and Wellness
  • Coalition of Black Trade Unionists
  • Coalition to Protect Parenthood After Cancer
  • Community Healthcare Network
  • Economic Opportunity Council of Suffolk
  • Families Together in New York State
  • Family Service League
  • International Rabbinic Fellowship
  • Long Island Breast Cancer Coalitions:
    • Babylon Breast Cancer Coalition
    • Islip Breast Cancer Coalition and Other Women’s Cancers
    • Coalition for Women’s Cancers at Southampton Hospital
    • LI2Day
    • Lucia’s Angels, Southampton Hospital
    • North Fork Breast Health Coalition
    • North Shore Neighbors Breast Cancer Coalition
    • Westlip Breast Cancer Coalition for Long Island
  • Long Island Chapter of the National Ovarian Cancer Coalition
  • Long Island Hispanic Chamber of Commerce
  • Morgan Stanley Children’s Hospital of New York-Presbyterian
  • Planned Parenthood Empire State Acts
  • Rabbinical Council of America
  • Roswell Park Cancer Institute
  • Stupid Cancer
  • The Center: The Lesbian, Gay, Bisexual & Transgender Community Center
  • Veterans of Foreign Wars Post 2192
  • Young Survival Coalition
  • UJA-Federation of New York
  • Union of Orthodox Jewish Congregations of America

Special Thanks to:

  • Risa A. Levine, RESOLVE Board Director, New York Resident
  • New York State Assemblymember Aravella Simotas, Assembly District 36
  • New York State Senator Diane Savino, Senate District 23
  • Tress Capitol Advisors, Albany, NY
  • Dickinson, Avella & Vidal, Albany, NY
  • Advocacy 2 Win
  • Blue Suit Strategies, New York
  • Agudath Israel of America
  • RESOLVE Staff: Barbara Collura, Betsy Campbell, Marnee Beck, Simmy Bookal, Rebecca Flick and Cindy Hollister

Resources:

Photos from New York Advocacy Days

News Articles:

Bills:

FAFTA: S719; A2817

Definition of Infertility in the 2020 Budget:

The definition of infertility that is in the 2020 Budget that will be used for the updated coverage is:

‘Infertility’ means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.