Victory in the Aloha State

After more than a decade of advocacy by Hawaiian patient and provider advocacy organizations, Hawaii Governor Josh Green signed HB 1864 into law on July 9, 2026. This legislation requires state-regulated health insurers to cover standard fertility preservation services for individuals facing iatrogenic infertility, including cancer patients. The new law will cover procedures such as sperm banking and egg and embryo freezing and go into effect for health plans issued or renewed in Hawaii after December 31, 2026.

Due to Hawaii’s Prepaid Health Care Act of 1974 (PHCA) – the nation’s only state employer health coverage mandate that predates federal ERISA law – coverage will reach a broader percentage of Hawaii’s population compared to other state fertility preservation laws. We estimate that more than 700,000 Hawaiians, approximately half of the state’s population, will now have fertility preservation coverage should they ever need it.

The Alliance for Fertility Preservation would like to thank every patient advocate and organization that has been fighting tirelessly for this coverage since the first Hawaii bill was introduced in 2012. We are especially grateful for the Hawaii Society of Clinical Oncology, ASCO, Fertility Institute of Hawaii, Breast Cancer Hawaii, ACS CAN, Blood Cancer United, Susan G. Komen and all of the patient advocates who bravely shared their stories throughout this long journey.

Fertility Preservation Toolkit

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Laws & Legislation

Over the past decade, states across the country have introduced bills that would establish coverage for fertility preservation. These bills would require certain insurers to cover fertility preservation procedures for cancer patients and others who are facing potential infertility as result of medical treatment (iatrogenic infertility). In 2017, the first two states—Connecticut and Rhode Island—passed those measures into law. Since then, a national trend toward coverage has developed.

We are thrilled to see this significant expansion of access, but much work remains to be done. The AFP has been working in collaboration with leading cancer and fertility organizations, oncology and reproductive clinicians, local patient groups, and individual patients in many of these states. If you are interested in getting involved in our efforts, please reach out at: info@a4fp.org.

This section displays a map of the United States with each state that has passed fertility preservation coverage colored green. States with active legislation are colored blue, and states with inactive legislation are colored light yellow. States with no coverage or legislation are white. The State List select field includes the highlighted states. Choosing a state from the select menu or clicking a state in the map will open that state's page in a new browser tab.

  • Coverage Enacted
  • Coverage Enacted; Additional Coverage Pending
  • Coverage Pending
  • Previous Legislation; No Coverage
  • No Legislation Introduced/No Coverage

Updated 7/9/2026
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