Governor Newsom calls on Trump administration to remove roadblocks to California’s expansion of essential health benefits, including IVF

Why HHS’s proposal falls short

HHS says its proposed rule is aimed at reducing rising premiums. However, California’s proposed additions to its benchmark plan are not a primary driver of premium increases.

In effect, the new proposed rule would lock states into outdated benefit standards, freezing benefits at levels established more than a decade ago, despite significant advances in medicine and technology. California’s proposal reflects modern care needs, including expanded access to fertility treatments and assistive devices.

What’s at stake for Californians

California’s updated benchmark plan, developed in partnership with the Legislature and submitted in May 2025, would expand coverage beginning in 2027 to include:

• Fertility services, including IVF
• Hearing aids, including for children
• Mobility devices such as wheelchairs

The proposal fully complies with federal actuarial requirements that severely limit premium increases.

Millions of Californians in the individual and small group markets could be denied access to these critical services if HHS proceeds with its proposed rule and continues to delay review of state applications. This runs counter to federal commitments to expand IVF access, including the President’s February 2025 Executive Order calling for ensuring reliable access to IVF treatment.

HHS is wasting time and resources

The HHS delay in reviewing EHB applications will result in a waste of resources for both states and federal staff who have begun reviewing those existing EHB applications. Unless HHS removes its pause immediately, California and other states with pending EHB applications will have to restart a years-long process of developing a new benchmark plan because the values of the “typical” employer plan will likely have changed.

In addition, the HHS failed to provide a reasonable amount of time for interested persons to participate in the proposed rulemaking. The HHS deadline for submission of comments in response to its proposed rule barely meets the minimum time of 30-days and is less than the comment period provided by HHS in previous years.

California remains committed to expanding access to modern, evidence-based care and ensuring families have access to the services they need to thrive.