FY2024 NDAA: Reproductive Health Care Provisions

FY2024 NDAA: Reproductive Health Care Provisions

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INSIGHTi

FY2024 NDAA: Reproductive Health Care
Provisions
Updated January 16, 2024
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 benefits and services through
its TRICARE program to approximately 9.6 million beneficiaries composed of servicemembers, military
retirees, and dependents. 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 an FY2024 NDAA, Congress has expressed interest in TRICARE
coverage policies for reproductive health care services (see CRS Insight IN12210, FY2024 NDAA: Status
of Legislative Activity). 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 proposed and enacted reproductive health care-related provisions included in the House-
passed (H.R. 2670) Senate-passed (S. 2226), and enacted (P.L. 118-31) versions of the FY2024 NDAA.

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IN12236
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Table 1. FY2024 NDAA Selected Legislative Proposals
House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Section 707 would have temporarily
No similar provision.
Not adopted.
prohibited DOD from 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 have been in effect for a one-
year period starting 30 days after
enactment.
Section 711 would have required the
Section 726 would have required the
Not adopted.
Secretary of Defense to establish a
Secretary of Defense to conduct a
one-year pilot program that provides
study on family planning in the military,
reimbursement for gamete
including trends of servicemembers
cryopreservation services for certain
who leave the Armed Forces for family
active duty servicemembers. The pilot
planning reasons, the availability of
program would have provided
gamete cryopreservation services and
reimbursement for no more than 200
its effect on retention, and methods
active duty servicemembers who are
and cost for DOD to offer gamete
awaiting or have received orders to
cryopreservation services. The
certain hazardous duty locations,
provision would have also required the
would be geographically separated
Secretary of Defense to brief the
from their spouse or partner, and have
House and Senate armed services
been approved to participate in the
committees on the results of the study
program.
not later than April 1, 2024.
Section 716 would have repealed the
No similar provision.
Not adopted.
October 20, 2022, DOD
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 have also amended 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 have amended 10
Not adopted.
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.
Source: CRS analysis of legislation on Congress.gov.

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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
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.”
For the FY2024 NDAA, Congress considered, but did not adopt, provisions that would have modified the
availability or cost-sharing requirements for reproductive health services.
Contraceptive Services
DOD offers contraceptive services as part of its family planning benefit in accordance with the FY2016
NDAA (P.L. 114-92 §718) and U.S. Centers for Disease Control and Prevention recommendations for
contraceptive use.
House Section 707 would have established a one-year prohibition on cost shares for TRICARE-covered
contraceptive services for certain beneficiaries. The provision would have required 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 have also
temporarily prohibited DOD from requiring or collecting cost shares for prescription contraceptives for
all beneficiaries except servicemembers and dependents of the Coast Guard, National Oceanic and
Atmospheric Administration Commissioned Officer Corps, Commissioned Corps of the U.S. Public
Health Service.
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. Senate
Section 703 would have amended 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 dependents.
Senate Section 726 would have required 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 these services. House Section 711 would have required the Secretary of Defense to
establish a one-year pilot program to provide reimbursement to no more than 200 active duty
servicemembers for gamete cryopreservation services.
While these provisions were not enacted, the conferees directed the Secretary of Defense to conduct a
study on the “feasibility and advisability of providing reimbursement to servicemembers for expenses
incurred in the testing, cryopreservation, shipping, and storage of gametes in a private storage facility

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deemed appropriate by the Secretary.” The Secretary is also required to brief the Armed Services
committees on the study no later than April 1, 2024.
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
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.”
House Section 716 would have repealed the October 20, 2022, DOD memorandum and prohibit DOD
from using funds to implement the memorandum or a potential successor memorandum. The provision
would have also amended 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

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IN12236 · VERSION 4 · UPDATED