Twenty-five states now require insurance coverage for fertility care as federal officials create new employer benefit pathways and negotiate lower drug prices. California delayed implementation of comprehensive IVF coverage mandates until 2026, while Virginia's commission drafted legislation requiring three IVF cycles in benchmark plans. Arkansas became the first state enacting restorative reproductive medicine legislation, though Nevada's governor vetoed broader Medicaid fertility coverage citing fiscal concerns.

State legislatures remain deeply divided on reproductive health policy in 2025. Following 2024 ballot measure victories for abortion protections in seven states, Republican lawmakers in Montana and Missouri are pushing counter-measures. States are clarifying emergency abortion exceptions amid legal challenges, while blue states codify EMTALA protections. Medication abortion faces ongoing restrictions in red states and protective measures in blue states.