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INSIGHTi
FY2024 NDAA: Reproductive Health Care
Provisions
September 6, 2023
Background
The Department of Defense (DOD) administers a health entitlement (under Chapter 55 of Title 10, U.S.
Code) through the Military Health System (MHS). The MHS offers health care benefits and services
through its TRICARE program to approximately 9.6 million beneficiaries composed of servicemembers,
military retirees, and dependent family members. Congress often specifies certain TRICARE coverage
parameters (e.g., how health care services may be delivered, and cost-sharing requirements) through the
National Defense Authorization Act (NDAA).
During ongoing deliberations on a fiscal year (FY) 2024 NDAA, Congress has expressed interest in
TRICARE coverage policies for reproductive health care services. TRICARE currently covers
• reproductive health screening and preventive services,
• contraceptive services (i.e., birth control), and
• infertility services (e.g., diagnostic services for assisted reproductive technologies or
ART).
Table 1 lists reproductive health care-related provisions included in the House-passed (H.R. 2670) and
the Senate-passed (S. 2226) versions of an FY2024 NDAA.
Congressional Research Service
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Table 1. FY2024 NDAA Selected Legislative Proposals
House-passed H.R. 2670
Senate-passed S. 2226
Section 707 would temporarily prohibit DOD from
No similar provision.
requiring and col ecting certain TRICARE cost shares for
prescription contraceptives; contraceptive services,
education, or counseling, and “any method of contraception
approved, granted, or cleared by the Food and Drug
Administration” offered under TRICARE Prime and
TRICARE Select for certain members of the uniformed
services their dependent family members. The temporary
prohibition would be in effect for a one-year period starting
30 days after enactment.
Section 711 would require the Secretary of Defense to
No similar provision.
establish a one-year pilot program that provides
reimbursement for gamete cryopreservation services for
certain active duty servicemembers. The pilot program
would provide reimbursement for no more than 200 active
duty servicemembers who are awaiting or have received
orders to certain hazardous duty locations, would be
geographically separated from their spouse or partner, and
have been approved to participate in the program.
Section 716 would repeal the October 20, 2022 DOD
No similar provision.
memorandum on “Ensuring Access to Reproductive Health
Care” and prohibit DOD from using funds to implement the
memorandum or potential successor memorandum. The
provision would also amend 10 U.S.C. §1093 to prohibit the
Secretary of Defense from paying for or reimbursing fees or
expenses for DOD health care providers to obtain a health
care license in a state for the purpose of providing abortion
services.
No similar provision.
Section 703 would amend 10 U.S.C. §§1074d, 1077, and
1086 to require TRICARE coverage of certain assisted
reproductive technologies, including intrauterine
insemination, for active duty servicemembers and their
dependent family members.
No similar provision.
Section 726 would require the Secretary of Defense to
conduct a study on family planning in the military, including
trends of servicemembers who leave the Armed Forces for
family planning reasons, the availability of gamete
cryopreservation services and its effect on retention, and
methods and cost for DOD to offer gamete
cryopreservation services. The provision would also require
the Secretary of Defense to brief the House and Senate
armed services committees on the results of the study not
later than April 1, 2024.
Source: CRS analysis of legislation on Congress.gov.
Discussion
The MHS offers care to approximately 4.7 million female beneficiaries, including 1.6 million women of
reproductive age (15-45). Generally, active duty servicemembers incur no out-of-pocket cost for
TRICARE-covered reproductive health services. Other beneficiaries may be subject to cost-sharing
requirements based on their TRICARE health plan, beneficiary category, and type of medical service
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received. Since 2021, Congress has considered legislation that would change how TRICARE covers
certain reproductive health services. Some organizations have supported the elimination of existing
TRICARE cost-sharing requirements for certain reproductive health services, while others have
advocated for expanded TRICARE coverage of ART. Other organizations have expressed concerns about
broader federal “costs and side effects” to promoting reproductive health and “widespread contraceptive
use.”
The House-passed and Senate-passed versions of an FY2024 NDAA include provisions that would
modify the availability or cost-sharing requirements for reproductive health services.
Contraceptive Services
DOD offers contraceptive services as part of its family planning benefit. Counseling and contraceptive
methods are offered in accordance with the FY2016 NDAA (P.L. 114-92 §718) and U.S. Centers for
Disease Control and Prevention recommendations for contraceptive use.
Section 707 of the House bill would establish a one-year prohibition on cost shares for TRICARE-
covered contraceptive services for certain beneficiaries. The provision would require the Secretary of
Defense to temporarily prohibit DOD from requiring or collecting certain TRICARE cost shares for
contraceptive services, education, or counseling; and “any method of contraception approved, granted, or
cleared by the Food and Drug Administration” offered under TRICARE Prime and TRICARE Select for
all beneficiaries except members of the Coast Guard and their dependents. The provision would also
temporarily prohibit DOD from requiring or collecting cost shares for prescription contraceptives for all
beneficiaries except members of the Coast Guard, National Oceanic and Atmospheric Administration
Commissioned Officer Corps, Commissioned Corps of the U.S. Public Health Service, and their
dependents.
Section 726 of the Senate bill would require the Secretary of Defense to conduct a study on family
planning in the military, including an analysis of servicemembers who leave the military for family
planning reasons, the availability of gamete cryopreservation services and its effect on retention, and
methods and cost for DOD to offer gamete cryopreservation services. The provision would also require
the Secretary of Defense to brief study results to the armed services committees by April 1, 2024.
Infertility Services
DOD offers certain infertility services as part of its family planning benefit. Federal regulation (32 C.F.R.
§199.4(g)(34)) prohibits DOD from paying for other types of infertility services (i.e., ART), except for
seriously ill or injured active duty servicemembers and their spouses diagnosed with infertility.
Section 703 of the Senate bill would amend 10 U.S.C. §§1074d, 1077, and 1086 to require TRICARE
coverage of certain ART (e.g., intrauterine insemination) for all active duty servicemembers and their
dependent family members. Section 711 of the House-passed bill would require the Secretary of Defense
to establish a one-year pilot program that provides reimbursement to certain active duty servicemembers
for gamete cryopreservation services. The program would provide reimbursement for no more than 200
active duty servicemembers who are awaiting or have received orders to certain hazardous duty locations,
would be geographically separated from their spouse or partner, and have been approved to participate in
the program.
Abortion-related Services
Statute (10 U.S.C. §1093) prohibits DOD from directly providing or paying for abortions, “except where
the life of the mother would be endangered if the fetus were carried to term or in a case in which the
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pregnancy is the result of an act of rape or incest.” DOD may provide medically necessary care and
services when related to a covered abortion. On October 20, 2022, the Secretary of Defense issued a
memorandum directing actions to ensure that servicemembers and their families “can access reproductive
health care and [DOD] health care providers can operate effectively.” The memo directed the department
to establish travel and transportation allowances for servicemembers and their dependents to obtain non-
covered reproductive health care that is unavailable in the “local area of a Service member’s permanent
duty station,” and establish a reimbursement program to assist a DOD health care provider with obtaining
a professional license in another state “in order to support the performance of their official duties.”
Section 716 would repeal the October 20, 2022 DOD memorandum and prohibit DOD from using funds
to implement the memorandum or a potential successor memorandum. The provision would also amend
10 U.S.C. §1093 to prohibit the Secretary of Defense from paying for or reimbursing fees or expenses for
DOD health care providers to obtain a health care license in a state for the purpose of providing abortion
services.
For more on TRICARE coverage of reproductive health services, see CRS Report R46785, Federal
Support for Reproductive Health Services: Frequently Asked Questions, CRS In Focus IF11504, Infertility
in the Military, CRS In Focus IF11109, Defense Health Primer: Selected Contraceptive Services, and
CRS Insight IN11960, FY2023 NDAA: Military Abortion Policies.
Author Information
Bryce H. P. Mendez
Specialist in Defense Health Care Policy
Disclaimer
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