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Fertility mandate expansions are being debated nationwide.

Costs are high and raise legitimate questions about whether fertility coverage should be mandated or considered elective.

Connecticut currently has a pair of bills working through the legislature that would impact coverage for fertility treatments and potential coverage of third-party reproduction.

H.B. 5374, An Act Concerning Health Coverage Mandates for Certain Health Conditions, addresses multiple mandates (including scalp cooling for chemo-induced hair loss, prosthetics/orthotics, and PANDAS/PANS).

During the committee process, it was amended (via substitute) to broaden the state’s existing infertility coverage mandate. The updated definition of 'infertility' now includes the inability to reproduce 'as an individual or with a partner,' among other criteria based on medical history, age, and the need for medical intervention (such as donor gametes or a gestational surrogate).

"For example, the bill’s definition of 'infertility' includes not only a diagnosed disease or impairment of reproductive function, but also circumstances in which an individual is unable to reproduce 'either as an individual or with their partner,'" according to testimony submitted by Leslie Wolfgang from the Family Institute. "That language moves beyond medical diagnosis and into personal or relational circumstances."

"While the bill does not explicitly reference surrogacy, it mandates coverage for the very procedures—egg retrieval, fertilization, and embryo creation—that make surrogacy possible," Wolfgang continued.

She warned the expanded definition could open the door to mandated coverage in non-medical situations, such as:

• single adults without a diagnosed medical infertility condition (including single males) who are unable to conceive due to lack of a partner;
• individuals of advanced reproductive age no longer able to carry a pregnancy due to non-disease factors; and
• individuals whose reproductive capacity has been impaired by prior treatments, including certain gender-affirming care procedures (puberty blockers, cross-sex hormones, or surgical removal of reproductive organs).

"In these cases, IVF is not treating a pathology," wrote Wolfgang. "It is subsidizing choices and involving reproductive arrangements that will include third parties, egg donors, gestational carriers and future newborns, infants and children."

She outlined significant policy consequences, including financial concerns, such as requiring all policyholders to subsidize expensive reproductive technologies that extend beyond traditional medical treatment into elective use.

Wolfgang is calling on the legislature to "restore clear medical-necessity limits, narrowly define infertility, and ensure that Connecticut does not inadvertently subsidize third-party reproduction practices without a more full public debate."

Critics, including the Family Institute, argue the broadened definition could lead to insurance coverage in non-medical scenarios, such as single individuals (including single males) without a diagnosed reproductive impairment seeking to have a child via surrogacy.

Supporters, including State Rep. Raghib Allie-Brennan and activist groups such as Reproductive Equity Now, argue the change modernizes an outdated definition and promotes "equity" for single individuals and LGBTQ+ families.

Besides that aspect of the debate, there is another consideration when it comes to mandating insurance coverage of surrogacy: surrogacy birth tourism.

The Washington Examiner wrote in March 2026:

"Wealthy Chinese families and individuals are increasingly turning to the U.S.’s booming surrogacy sector to have their biological babies born on U.S. soil — often, without the parents themselves setting foot in the country. Foreigners, the plurality of whom are Chinese, initiated nearly 5,000 pregnancies this way during 2020 alone, despite the COVID-19 pandemic, according to a report published by the American Society for Reproductive Medicine. A recent Wall Street Journal investigation found that, in some cases, individual Chinese nationals have sought to commission over 100 children spread across dozens of surrogate mothers."

Surrogacy-related birth tourism is one of the issues raised in debates surrounding Donald Trump's birthright citizenship case at the Supreme Court.

At the same time, H.B. 5483, An Act Concerning Fertility Care Under the Medicaid Program, has been introduced to provide Medicaid coverage for fertility care.

Peter Wolfgang, President of the Family Institute, expressed concern that the bill would significantly expand Medicaid beyond its core purpose, redirecting "limited public resources toward expensive, elective procedures that serve a relatively small population."

"Even if surrogacy itself is not directly covered, the bill facilitates pathways that rely on third-party reproduction," he wrote. "This raises concerns about the commodification of human reproduction and the involvement of multiple parties—often with legal and ethical complexities that public programs are not well-equipped to manage."

"Should taxpayers be asked to subsidize expensive reproductive technologies when other essential services remain underfunded?" he wondered.

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