Committee hears bill to require insurer coverage for fertility preservation; budget and implementation costs debated

Assembly Bill 428, sponsored by Assemblymember Tanya Flanagan, would require certain public and private health plans — including Medicaid and plans for state and local government employees — to cover medically necessary fertility preservation procedures when an insured has a cancer diagnosis or will receive treatment likely to cause infertility. The bill includes an exemption for insurers affiliated with religious organizations if they provide written notice that they do not provide the coverage.

Flanagan told the committee the bill matches laws passed in other states and cited national statistics on breast cancer incidence and the potential affected population in Nevada.

Fiscal testimony and implementation timing

Nevada Medicaid staff noted the bill as amended to delay implementation (an amendment the sponsor said she would accept) would reduce the state general fund fiscal note. Stacy Weeks (Nevada Medicaid) said the delay to align with plan year timing and to obtain any necessary federal waivers reduces the FY26 state general fund impact to $228,034. Anne Jensen (Nevada Medicaid) gave total computable costs of $384,400 for FY26 and $263,371 for FY27 (total computable includes federal funds).

Adam Plaine with the Division of Insurance explained the division’s fiscal note as an item tied to federal essential health benefits determinations; the division estimated roughly $175,000 per fiscal year (first fiscal year's estimate reflects half a plan year) under the federal process for identifying state‑mandated benefits that could increase costs in the individual market. Plaine said if implementation is delayed by a year (implementation Jan. 1, 2027) the FY26 fiscal note would drop to zero and FY27 would reflect the adjusted first full plan‑year effects.

Local costs and concerns

Clark County— which operates a self‑funded health plan covering about 34,000 members—testified in neutral and provided an actuarial estimate of approximately $1.5 million per year in additional costs if the benefit is added. Other local government fiscal notes (Elko, Carson City, Henderson, etc.) had been filed for the record but representatives were not always available at the hearing to present them.

Opposition and legal concerns

One speaker who identified herself as Nancy Carlson said she supported the bill’s goals but urged caution that the bill excludes many cancer types that can affect fertility and does not account for age‑related differences in preservation success; she raised potential litigation risk and urged amendments.

Support

UNLV, professional associations representing speech/language and audiology clinicians, and other advocates were not involved in this bill’s hearing; several medical‑policy groups are listed in the fiscal record for related hearings. The sponsor and Medicaid officials said they would accept an implementation delay to January 1, 2027 (as discussed in committee) to reduce immediate fiscal impact and align with plan year implementation.

Why it matters: AB428 would create a new mandated benefit for insured Nevadans with cancer diagnoses that could impair fertility. The state and local cost estimates differ substantially depending on assumptions; the committee heard both the Medicaid estimate (which included federal match) and a local self‑insured employer estimate.