I was about to complete my first year of medical school. A friend had recently asked whether studying so many illnesses made me anxious about my own health. My answer came quickly: “Not really.”

For every disease, we also learned the risk factors and, as a healthy young person, I figured most of them didn’t apply to me. Then, just a few weeks before my final exams, I was diagnosed with invasive ductal carcinoma.

I first noticed a lump in my breast about a year ago, but I didn’t worry much because I knew that as a woman under 30, I was much more likely to have a benign mass than a malignancy. But probabilities describe populations, not individuals, and any scenario with a non-zero probability may come to pass. So, I found myself in this unlikely world in which I’m 28 and now undergoing breast cancer treatment.

Part of my treatment involves chemotherapy, which is toxic to the ovaries. With the clock of my looming treatment ticking, my medical team encouraged me to consider freezing my eggs.

As a student who has no income and who is too old to be on my parents’ health insurance, I am enrolled in Utah Medicaid. My cancer care navigators told me that, unfortunately, they were not aware of a single fertility clinic in Utah that accepts Medicaid for fertility preservation. They referred me to RMA Utah, where the financial team told me plainly: “We are not contracted with Medicaid. We can not bill them. You would need to self pay for your cycle.”

The already fear-inducing prospect of undergoing egg retrieval became all the more terrifying when I realized I would have to pay thousands of dollars for a single cycle.

At first, I assumed Medicaid simply doesn’t cover fertility preservation but, as I started to dig deeper, I learned that in Utah, it does.

Utah is one of only five states in the country where Medicaid covers fertility preservation for cancer patients. In 2021, the Utah Legislature approved a Medicaid waiver for fertility preservation services, which took effect in 2023. Yet the legal promise of Medicaid coverage means nothing if no clinic will accept Medicaid.

If we as a state have decided that a service is a fundamental component of healthcare, then why is it still inaccessible to Medicaid patients who often cannot afford to pay out-of-pocket?

Finances can make or break a person’s ability to pursue fertility preservation. Insurance coverage and socioeconomic status are among the strongest predictors of whether young cancer patients ultimately receive fertility preservation, and financial barriers are one of the primary reasons they do not. Beyond fertility itself, reproductive concerns are associated with greater psychological distress during cancer treatment and into survivorship.

Utah has already recognized the importance of fertility preservation in the cancer population by expanding Medicaid coverage. However, even states like Utah with insurance mandates can leave patients facing “inconsistent application and unclear benefits” as a result of ineffective implementation.

Providing healthcare services covered by Medicaid is not just a moral obligation, but also a legal one. The Medicaid Equal Access Provision requires states to ensure that covered services are available to Medicaid beneficiaries to the same extent they are available to the general population. In practice, the law is difficult to enforce. The Supreme Court further limited patients’ options in Armstrong v. Exceptional Child Center (2015), holding that private parties cannot sue to enforce the provision.

As a patient, my best recourse is to file a complaint with Utah Medicaid and hope that someone investigates.

When I called Utah Medicaid, the representative confirmed that the egg freezing procedure should be covered and was surprised I could not find a participating provider. She gave me a list of in-network providers, but they all practice at RMA Utah, which does not accept Medicaid.

On paper, Utah Medicaid appears to have an adequate provider network, but in reality, no clinic will accept my insurance. The disconnect between Medicaid’s records and reality reveals a serious gap between promised and available care.

This is not just a Utah problem. Similar barriers have been reported for Medicaid patients in New York and even for patients with private insurance in Massachusetts. Access to fertility preservation remains fragmented by piecemeal policy and confusion over insurance coverage.

Utah DHHS already has the explicit goal to “improve access to fertility preservation services for Medicaid eligible individuals diagnosed with cancer.” I urge them to finish the job they started by reviewing how this benefit is being implemented and ensuring Medicaid patients can access the care the state has promised. Otherwise, the law serves as a false promise for patients like me hoping to cover the cost of an important medical procedure.

I hope future Medicaid patients unexpectedly burdened with a cancer diagnosis do not have to choose between preserving their fertility and paying for it. We already have enough to worry about.

Katya Brooun is a first-year medical student at the University of Utah and a cancer patient at Huntsman Cancer Institute. She is pursuing a graduate certificate in Tribal, Rural and Underserved medicine and is especially interested in health system improvement.

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