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  5. Implementation of state health insurance benefit mandates for cancer-related fertility preservation

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Implementation of state health insurance benefit mandates for cancer-related fertility preservation: following policy through a complex system

Summary

This study aimed to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services.

The Challenge

In 2019, California passed the fertility preservation benefit mandate known as Senate Bill (SB) 600, which was intended to improve access to fertility preservation services for individuals at risk of infertility due to cancer treatments. However, the implementation of this mandate has been inconsistent and led to variability in how the mandate was interpreted, applied, and ultimately how it impacted patients' access to these essential service

The Approach

The study’s objective was to use the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to investigate California’s fertility preservation benefit mandate implementation in a health system comprised of state insurance regulator, insurers, and clinics and identify key policies, processes, and actors within and between contexts that impact access to a mandated fertility preservation health insurance benefit. Researchers reviewed public documents on the mandate's creation, passage, and implementation and conducted interviews with stakeholders who used fertility preservation in California. Using the findings from the document review and interviews,  the researchers were able to specify where policy, systems, and service entities existed within the implementation process and characterize the contexts and interrelationships among these entities.

The Impact

This research outlines the critical factors and roles involved in fertility preservation service access related to the benefit mandates, providing insights for evaluating implementation determinants and improving future mandates and strategies.

Key Benefits

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Healthcare Accessibility- Potential

The study's findings about disparities in coverage and the challenges patients faced in accessing fertility preservation services despite the mandate provide critical data to potentially inform future efforts to improve accessibility​.
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Healthcare Delivery- Potential

Highlighted variations in how insurers and clinics applied the mandate, which impacted service delivery and patient experience. The study’s evaluation of these processes contributes to improving healthcare delivery by identifying where miscommunication or policy gaps led to suboptimal care.
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Policies & Legislation- Demonstrated

By tracking how the state-level mandate was operationalized through various contexts and roles, this investigation contributes to the broader understanding of barriers and facilitators to the implementation, adaptation, and sustainability of policies.

Download the Implementation of state health insurance benefit mandates for cancer-related fertility preservation Impact Profile

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Additional Resources

  • Published articles:
    • Su, H. I., Kaiser, B. N., Crable, E. L., Ortega, R. F., Yoeun, S. W., Economou, M. A., Fernandez, E., Romero, S. A. D., Aarons, G. A., & McMenamin, S. B. (2024). Implementation of state health insurance benefit mandates for cancer-related fertility preservation: following policy through a complex system. Implementation science : IS, 19(1), 14. https://doi.org/10.1186/s13012-024-01343-1
    • Crable, E. L., Lengnick-Hall, R., Stadnick, N. A., Moullin, J. C., & Aarons, G. A. (2022). Where is "policy" in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example. Implementation science : IS, 17(1), 80. https://doi.org/10.1186/s13012-022-01256-x
  • Senate Bill referred to in this project:
    • Portantino: Senate Bill No. 600: an act to add Section 1374.551 to the Health and Safety Code, relating to health care coverage., in California So (ed), 2019.