State Laws Aim To Reverse Baby Bust And Cut IVF Costs

As the U.S. birth rate continues to drop, a growing number of states have passed laws to improve access to fertility treatments, lessen related costs, and grant time off for employees experiencing reproductive losses. This article summarizes the recent changes in state and federal policies.

Quick Hits

• A number of state laws enacted in 2024 or 2025 aim to expand insurance coverage for fertility treatments or give employees time off for reproductive losses or to care for a newborn in intensive care.
• More states could decide to continue this trend in 2026.
• The 2025 federal budget reconciliation bill instituted Trump Accounts with $1,000 contributions for newborns who are American citizens.

The following states and localities recently passed laws concerning insurance coverage or leaves of absence related to pregnancy, childbirth, or fertility treatments.

• California: On September 29, 2024, Governor Gavin Newsom signed Senate Bill (SB) No. 729 into law, requiring large insured group health plans to cover diagnosis and treatment of infertility. This includes coverage for in vitro fertilization (IVF) with up to three egg retrievals and unlimited embryo transfers. This law took effect on July 1, 2025. Another law took effect in January 2024 to require California employers to provide five days of paid leave for employeesafter amiscarriage, stillbirth, failed surrogacy, failed adoption, or unsuccessful assisted reproduction procedure.
• Colorado: Governor Jared Polis signed into law a bill that expands the state's Family and Medical Leave Insurance (FAMLI) program to provide up to twelve weeks of paid leave for parents with a child in a neonatal intensive care unit (NICU). It will take effect on January 1, 2026.
• District of Columbia: The Expanding Access to Fertility Treatment Amendment Act of 2023 mandates that large insured group health plans cover diagnosis and treatment of infertility, including IVF and fertility preservation methods. It took effect on January 1, 2025.
• Florida: Lawmakers passed a bill to require state health insurance plans to cover medically necessary fertility preservation services. The law took effect on July 3, 2025, without the governor's signature. It applies to insurance policies issued on or after January 1, 2026.
• Georgia: On May 1, 2025, Governor Brian Kemp signed a House Bill (HB) 94, which mandates health insurance coverage for medically necessary fertility preservation services for patients with certain diseases, such as cancer, sickle cell disease, and lupus. It applies to insurance coverage renewed or issued after January 1, 2026. The governor also signed a different HB 428 to codify the right to obtain IVF in the state. That law took effect on July 1, 2025.
• Illinois: Governor J.B. Pritzker signed the Neonatal Intensive Care Leave Act (NICLA), which provides unpaid leave for parents with a child in a NICU. It will take effect on June 1, 2026.
• Tennessee: On April 24, 2025, Governor Bill Lee signed the Fertility Treatment and Contraceptive Protection Act (House Bill 533), which codified the right to obtain fertility treatments and contraception in the state. This law took effect on July 1, 2025.

At the federal level, on October 16, 2025, President Donald Trump issued an executive order that permits employers to offer standalone benefit packages to employees to cover IVF and other infertility treatments. The order also announced an agreement with a drug manufacturer to reduce prices for fertility medications.

On July 4, 2025, President Trump signed the budget reconciliation bill, which includes a provision to put $1,000 into Trump Accounts for newborns who are U.S. citizens. For babies born between January 1, 2025, and December 31, 2028, the U.S. government will deposit $1,000 into a Trump Account, invested in a stock-market index fund. The federal deposits are expected to start in July 2026. The money can earn interest over time and be withdrawn any time after the child turns eighteen years old. An employer can contribute up to $2,500 per year to the Trump Account of an employee's child, and the employer's contribution will not count toward the employee's taxable income.

When combined, these state and federal actions represent a mounting policy trend to provide support for individuals trying to conceive and care for newborns.

The out-of-pocket costs for IVF, pregnancy, and childbirth remain an impediment for some Americans. Among reproductive-age women who reported needing fertility services at some point, 12 percent said cost was the primary reason they did not receive fertility services, according to 2024 research from the Kaiser Family Foundation (KFF). Meanwhile, 27 percent of large companies that offered health benefits covered IVF in 2024, KFF reported.

Next Steps

Employers must comply with any new state laws that require insurance coverage for fertility treatments and time off for reproductive losses or to care for a newborn in intensive care. Time off under state family leave programs may run concurrently with qualified leave taken under the federal Family and Medical Leave Act (FMLA), depending upon eligibility.