NY State Infertility Demonstration Program
Genesis Fertility & Reproductive Medicine has been selected by the New York State Department of Health to participate in the Infertility Demonstration Program. This selection is based upon several quality parameters and our superior pregnancy success rates. Through this grant, qualified individuals can obtain financial assistance for an IVF cycle. These grants can reduce the burden of infertility treatment cost.
The NYS DOH Infertility Demonstration Program provides financial support to privately insured individuals whose insurance coverage for IVF is exhausted or inadequate. They must meet certain other criteria, including having exhausted appropriate lower level infertility services, are residents of New York State and meet the age and health guidelines established by the State.
The State has determined cost sharing amounts that patients will be required to pay. These cost amounts vary by the patient’s household income. Financial support is available on a sliding scale basis and extends to patients with household incomes up to $195,000.
The New York State Department of Health created a mandate in 2003 to provide financial subsidy grants so that more patients could access the infertility treatment they need.
To apply for the NY State grant, patients must provide proof of:
- Age between 21 – 44 years
- New York state residency
- Private health insurance as primary insurance (not Medicaid, Medicare, or Family Health Plus)
- Combined gross household income, determined by most recent tax returns, of under $195k annually
Patients’ insurance plan cannot provide coverage for IVF, but it can cover medications, blood work, or sonograms.
Qualified patients will pay a cost share amount (their out-of-pocket expense) determined by NY state guidelines, based on total household income level, ranging from 2.5 percent of the total costs to 97.5 percent of the costs.
Services eligible for the NY state program include:
- Patient assessment (only one allowed per patient for the life of the grant)
- IVF cycles (maximum of two complete cycles per patient for the life of the grant), including
- Medications for ovulation induction
- Monitoring of ovulation induction
- All laboratory & sonography testing
- Egg retrieval
- Laboratory (in vitro) fertilization
- Intracytoplasmic sperm injection (ICSI) as required
- Embryo transfer
The NY state grant requires that some patients try intrauterine insemination (IUI) before moving to IVF. Some patients, though, will be waived through if the physician determines IVF is optimal and preferred.
Patients who have very low likelihood of pregnancy with IVF are ineligible for the NY state grant. Examples of related conditions include:
- abnormal FSH level
- history of 3 or more unsuccessful IVF cycles
- several incomplete (canceled) cycles
For more information, contact our billing office at 718-331-3516