Grant Number:	1R01CA297797-01A1 Interpret this number
Primary Investigator:	Su, Hui-Chun
Organization:	University Of California, San Diego
Project Title:	Health Insurance Benefit Mandates: Impact of Policy on the Affordability and Utilization of Fertility Preservation Services in Children, Adolescents and Young Adults with Cancer
Fiscal Year:	2026

Project summary Benefit mandates (laws that require health insurance coverage of specific healthcare services) are a public health intervention aimed to standardize coverage and increase access to care. The objective of this proposal is to examine how state benefit mandates for medically indicated fertility preservation (FP) impact affordability and utilization of FP services by young people with cancer. Cancer treatments can directly harm fertility. FP before cancer treatment, i.e., oocyte, embryo, sperm, and ovarian tissue freezing, are evidence-based practices that effectively decrease medically-induced infertility, a life-changing outcome. Historically, FP services were not covered by health insurance and unaffordable. Since 2017, 18 states have passed FP benefit mandates to increase access to care. Our preliminary, qualitative work in 3 states found that 1) FP benefit mandates are not working as intended, 2) the field lacks large-scale, national data on mandates’ effectiveness in increasing utilization and affordability, and 3) these data would be used by multi-level partners to inform future insurer practices, clinical guidelines and efforts for meaningful FP insurance coverage. To address this gap, we will conduct a 3-year study to investigate how state benefit mandates for medically indicated FP impact affordability and utilization by children, adolescents and young adults who are newly diagnosed with cancer and generate research dissemination tools to engage multi-level partners. Using U.S. administrative data, a cohort of young people ages 0 to 39 who are newly diagnosed with cancer between 2012 and 2024 will be identified. First, outcomes of utilization and affordability of FP services using insurance will be characterized. Enrollee demographic, cancer, insurance and geographic characteristics associated with outcomes will provide novel, national data on who is able to use insurance to undergo FP. To test the hypothesis that FP services are not covered at the same level as other cancer services, we will compare in-network care and co-insurance rates between FP and other cancer services. Second, we will test the hypothesis that FP utilization will be higher, and cost-sharing will be lower with benefit mandates using a staggered difference-in-difference design. Due to wide variation in mandate design, we will explore how different aspects of mandates affect outcomes. Finally, we will innovate research-to-practice tools to disseminate research evidence to multi-level partners. This project takes an impactful approach to the evaluation of any insurance mandate in which the array of covered services could be highly subject to interpretation. To date, our early findings and timely dissemination have already led to changes in a single state’s insurance guidance and a clinical guideline. For multi-level partners nationwide, quantitative evidence from this proposal is sought and will directly inform future practices on FP insurance coverage to support the reproductive goals of young cancer patients. Funds will not be used for lobbying or to advocate for specific positions.





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