California IVF mandate helps large employers but leaves many patients without coverage

In January 2026 California enacted SB 729, requiring insurers to fund in-vitro fertilization for employees of fully insured companies with at least 100 workers and for CalPERS beneficiaries, a provision praised as the most inclusive in the nation. The law covers multiple egg retrievals, unlimited embryo transfers and expands eligibility to LGBTQ+ and single individuals. However, it excludes employees of small businesses, those on marketplace or Medi-Cal plans, the uninsured and self-funded employer plans, leaving millions without coverage.

Patients such as 40-year-old Nicole Torres received denial notices because her small-brewery employer does not meet the size threshold, leading her to seek employment with fertility benefits or consider loans. Los Angeles fertility clinics have observed about a 20% increase in patients, many of whom delayed treatment due to cost. Nonetheless, significant expenses—donor compensation, agency fees, legal costs, and certain procedures—remain uncovered, and many patients are uncertain about policy details, highlighting the need for broader federal action.