US IVF Access Rankings (2026)
All 51 US jurisdictions ranked by a composite access gap score combining affordability (40%), insurance coverage strength (30%), and clinic density per million residents (30%). Lower score = better access. Data covers 449 CDC-reporting clinics, 2022 reporting year.
Access gap by state
Hover a state for its access gap score, affordability ratio, coverage score, and clinic density. Green = best access; red = worst.
At a glance
- Best-access state
- District of Columbia
- gap score 0.126
- Worst-access state
- Idaho
- gap score 0.859
- Median affordability ratio
- 64%
- of median household income
- “Unaffordable” states
- 1
- ratio > 80% of income
Top 10 — best IVF access
| # | State | Gap score | Affordability | Coverage | Clinics / 1M | Band |
|---|---|---|---|---|---|---|
| 1 | District of Columbia | 0.126 | 21% | 0.90 | 2.95 | Very affordable |
| 2 | New York | 0.143 | 24% | 0.90 | 2.25 | Very affordable |
| 3 | California | 0.144 | 22% | 0.90 | 2.18 | Very affordable |
| 4 | Delaware | 0.145 | 21% | 0.90 | 1.94 | Very affordable |
| 5 | Illinois | 0.166 | 20% | 0.90 | 1.67 | Very affordable |
| 6 | Colorado | 0.193 | 20% | 0.90 | 1.36 | Very affordable |
| 7 | Massachusetts | 0.244 | 22% | 0.90 | 1.14 | Very affordable |
| 8 | Connecticut | 0.331 | 40% | 0.55 | 1.94 | Strained |
| 9 | Hawaii | 0.343 | 52% | 0.55 | 3.48 | Strained |
| 10 | New Jersey | 0.351 | 38% | 0.55 | 1.51 | Affordable |
Bottom 10 — worst IVF access
| Rank | State | Gap score | Affordability | Coverage | Clinics / 1M | Band |
|---|---|---|---|---|---|---|
| 51 | Idaho | 0.859 | 68% | 0.00 | 0.51 | Severely strained |
| 50 | Wyoming | 0.853 | 63% | 0.00 | 0.00 | Severely strained |
| 49 | South Carolina | 0.852 | 73% | 0.00 | 0.74 | Severely strained |
| 48 | Oklahoma | 0.851 | 72% | 0.00 | 0.74 | Severely strained |
| 47 | Iowa | 0.839 | 64% | 0.00 | 0.62 | Severely strained |
| 46 | Kentucky | 0.820 | 76% | 0.00 | 0.88 | Severely strained |
| 45 | Michigan | 0.817 | 66% | 0.00 | 0.80 | Severely strained |
| 44 | Louisiana | 0.812 | 79% | 0.10 | 0.87 | Severely strained |
| 43 | New Mexico | 0.797 | 78% | 0.00 | 0.95 | Severely strained |
| 42 | Pennsylvania | 0.790 | 64% | 0.00 | 0.85 | Severely strained |
Full table — all 51 jurisdictions
Sortable via the column clicks in a spreadsheet — download CSV or download JSON.
| State | Income | Pop. | Clinics | Per 1M | Cycle $ | Total $ | OOP $ | Ratio | Cov. | Gap | Band |
|---|---|---|---|---|---|---|---|---|---|---|---|
| District of Columbia | $101,027 | 0.7M | 2 | 2.95 | $20,496 | $60,992 | $21,347 | 21% | 0.90 | 0.126 | Very affordable |
| New York | $81,386 | 19.6M | 44 | 2.25 | $17,514 | $55,028 | $19,260 | 24% | 0.90 | 0.143 | Very affordable |
| California | $91,905 | 39.0M | 85 | 2.18 | $19,390 | $58,780 | $20,573 | 22% | 0.90 | 0.144 | Very affordable |
| Delaware | $79,325 | 1.0M | 2 | 1.94 | $14,154 | $48,308 | $16,908 | 21% | 0.90 | 0.145 | Very affordable |
| Illinois | $78,433 | 12.5M | 21 | 1.67 | $12,894 | $45,788 | $16,026 | 20% | 0.90 | 0.166 | Very affordable |
| Colorado | $87,598 | 5.9M | 8 | 1.36 | $14,714 | $49,428 | $17,300 | 20% | 0.90 | 0.193 | Very affordable |
| Massachusetts | $96,505 | 7.0M | 8 | 1.14 | $20,510 | $61,020 | $21,357 | 22% | 0.90 | 0.244 | Very affordable |
| Connecticut | $90,213 | 3.6M | 7 | 1.94 | $15,834 | $51,668 | $36,168 | 40% | 0.55 | 0.331 | Strained |
| Hawaii | $94,814 | 1.4M | 5 | 3.48 | $25,242 | $70,484 | $49,339 | 52% | 0.55 | 0.343 | Strained |
| New Jersey | $96,346 | 9.3M | 14 | 1.51 | $15,848 | $51,696 | $36,187 | 38% | 0.55 | 0.351 | Affordable |
| New Hampshire | $90,845 | 1.4M | 1 | 0.71 | $15,456 | $50,912 | $17,819 | 20% | 0.90 | 0.384 | Very affordable |
| Utah | $86,833 | 3.4M | 4 | 1.17 | $13,930 | $47,860 | $33,502 | 39% | 0.55 | 0.403 | Affordable |
| Rhode Island | $81,854 | 1.1M | 1 | 0.91 | $15,400 | $50,800 | $35,560 | 43% | 0.55 | 0.507 | Strained |
| Texas | $73,035 | 30.5M | 44 | 1.44 | $12,978 | $45,956 | $41,360 | 57% | 0.25 | 0.529 | Strained |
| Maryland | $98,461 | 6.2M | 5 | 0.81 | $16,310 | $52,620 | $36,834 | 37% | 0.55 | 0.531 | Affordable |
| Vermont | $74,014 | 0.6M | 2 | 3.09 | $16,030 | $52,060 | $52,060 | 70% | 0.00 | 0.587 | Severely strained |
| Washington | $90,325 | 7.8M | 12 | 1.54 | $15,638 | $51,276 | $51,276 | 57% | 0.00 | 0.587 | Strained |
| Kansas | $69,747 | 2.9M | 5 | 1.70 | $12,194 | $44,388 | $44,388 | 64% | 0.00 | 0.602 | Severely strained |
| Nevada | $71,646 | 3.2M | 6 | 1.88 | $14,112 | $48,224 | $48,224 | 67% | 0.00 | 0.611 | Severely strained |
| Maine | $68,251 | 1.4M | 1 | 0.72 | $15,610 | $51,220 | $35,854 | 53% | 0.55 | 0.615 | Strained |
| Virginia | $87,249 | 8.7M | 11 | 1.26 | $14,196 | $48,392 | $48,392 | 56% | 0.00 | 0.630 | Strained |
| Missouri | $65,920 | 6.2M | 9 | 1.45 | $12,306 | $44,612 | $44,612 | 68% | 0.00 | 0.643 | Severely strained |
| Alaska | $84,814 | 0.7M | 1 | 1.36 | $17,780 | $55,560 | $55,560 | 66% | 0.00 | 0.652 | Severely strained |
| North Dakota | $73,959 | 0.8M | 1 | 1.28 | $13,230 | $46,460 | $46,460 | 63% | 0.00 | 0.653 | Severely strained |
| Arkansas | $55,432 | 3.1M | 1 | 0.33 | $12,306 | $44,612 | $31,228 | 56% | 0.55 | 0.654 | Strained |
| Arizona | $72,581 | 7.4M | 10 | 1.35 | $15,050 | $50,100 | $50,100 | 69% | 0.00 | 0.672 | Severely strained |
| South Dakota | $69,457 | 0.9M | 1 | 1.09 | $12,936 | $45,872 | $45,872 | 66% | 0.00 | 0.702 | Severely strained |
| Wisconsin | $72,458 | 5.9M | 6 | 1.02 | $13,314 | $46,628 | $46,628 | 64% | 0.00 | 0.702 | Severely strained |
| Florida | $67,917 | 22.6M | 26 | 1.15 | $14,392 | $48,784 | $48,784 | 72% | 0.00 | 0.707 | Severely strained |
| West Virginia | $55,948 | 1.8M | 2 | 1.13 | $12,278 | $44,556 | $44,556 | 80% | 0.10 | 0.720 | Severely strained |
| Nebraska | $71,722 | 2.0M | 2 | 1.01 | $12,838 | $45,676 | $45,676 | 64% | 0.00 | 0.723 | Severely strained |
| North Carolina | $66,186 | 10.8M | 11 | 1.02 | $13,272 | $46,544 | $46,544 | 70% | 0.00 | 0.731 | Severely strained |
| Indiana | $67,173 | 6.9M | 7 | 1.02 | $12,740 | $45,480 | $45,480 | 68% | 0.00 | 0.733 | Severely strained |
| Minnesota | $84,313 | 5.7M | 5 | 0.87 | $13,174 | $46,348 | $46,348 | 55% | 0.00 | 0.742 | Strained |
| Tennessee | $64,035 | 7.1M | 7 | 0.98 | $12,642 | $45,284 | $45,284 | 71% | 0.00 | 0.757 | Severely strained |
| Georgia | $71,355 | 11.0M | 10 | 0.91 | $12,754 | $45,508 | $45,508 | 64% | 0.00 | 0.759 | Severely strained |
| Montana | $66,341 | 1.1M | 1 | 0.88 | $13,356 | $46,712 | $46,712 | 70% | 0.10 | 0.762 | Severely strained |
| Oregon | $76,362 | 4.2M | 4 | 0.94 | $16,114 | $52,228 | $52,228 | 68% | 0.00 | 0.766 | Severely strained |
| Alabama | $59,673 | 5.1M | 5 | 0.98 | $12,306 | $44,612 | $44,612 | 75% | 0.00 | 0.779 | Severely strained |
| Ohio | $66,990 | 11.8M | 10 | 0.85 | $13,132 | $46,264 | $46,264 | 69% | 0.10 | 0.786 | Severely strained |
| Mississippi | $52,985 | 2.9M | 3 | 1.02 | $11,970 | $43,940 | $43,940 | 83% | 0.00 | 0.788 | Unaffordable |
| Pennsylvania | $73,170 | 13.0M | 11 | 0.85 | $13,384 | $46,768 | $46,768 | 64% | 0.00 | 0.790 | Severely strained |
| New Mexico | $58,722 | 2.1M | 2 | 0.95 | $12,838 | $45,676 | $45,676 | 78% | 0.00 | 0.797 | Severely strained |
| Louisiana | $57,852 | 4.6M | 4 | 0.87 | $12,740 | $45,480 | $45,480 | 79% | 0.10 | 0.812 | Severely strained |
| Michigan | $68,505 | 10.0M | 8 | 0.80 | $12,684 | $45,368 | $45,368 | 66% | 0.00 | 0.817 | Severely strained |
| Kentucky | $60,183 | 4.5M | 4 | 0.88 | $12,880 | $45,760 | $45,760 | 76% | 0.00 | 0.820 | Severely strained |
| Iowa | $70,571 | 3.2M | 2 | 0.62 | $12,642 | $45,284 | $45,284 | 64% | 0.00 | 0.839 | Severely strained |
| Oklahoma | $61,364 | 4.1M | 3 | 0.74 | $12,012 | $44,024 | $44,024 | 72% | 0.00 | 0.851 | Severely strained |
| South Carolina | $63,623 | 5.4M | 4 | 0.74 | $13,342 | $46,684 | $46,684 | 73% | 0.00 | 0.852 | Severely strained |
| Wyoming | $72,495 | 0.6M | 0 | 0.00 | $12,936 | $45,872 | $45,872 | 63% | 0.00 | 0.853 | Severely strained |
| Idaho | $70,214 | 2.0M | 1 | 0.51 | $13,804 | $47,608 | $47,608 | 68% | 0.00 | 0.859 | Severely strained |
Methodology
Access gap score is a composite index combining three normalised inputs:
- Affordability (40%) — modelled state out-of-pocket cost divided by median household income (capped at 100%)
- Coverage (30%) — inverse of the coverage quality score (0.9 full mandate, 0.55 partial, 0.25 must-offer, 0.10 diagnostic-only, 0.00 none)
- Geographic access (30%) — inverse of the state’s clinic-density percentile (CDC-reporting clinics ÷ population, ranked across all 51 jurisdictions)
Affordability bands: very affordable (<25% income), affordable (25–40%), strained (40–60%), severely strained (60–80%), unaffordable (>80%).
Data inputs use the same pipeline as /us/press/true-cost-of-ivf: CDC NASS ART Summary 2022, US Census ACS 2022 5-yr, Census population Vintage 2023, MERIC Cost of Living Index 2023, state statute text, and TreatCompare’s affordability models. Full source code at the link above’s methodology section.
These are directional rankings for journalism and patient education, not pricing guarantees. Clinic-level variation within a state is significant — a patient at a mid-market clinic in a “severely strained” state may find better economics than a patient at a premium urban clinic in an “affordable” state. Use the ratios as state-to-state comparisons, not as individual-patient cost predictions.