The MediKids Act expands Medicaid eligibility to cover children and young adults up to age 26, regardless of their immigration status, and establishes a system for automatic enrollment of newborns that allows parents to opt out if other qualifying health coverage is available. The bill ensures that states provide full federal funding for these expanded groups and extends specific pediatric health services, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), to individuals up to age 26. Additionally, the legislation modifies tax rules to prevent this new Medicaid coverage from counting as minimum essential coverage for the purpose of individual health insurance tax penalties.
The MAIL Act allows unhoused or housing-unstable individuals with low incomes who receive specific federal assistance to rent free post office boxes. To qualify, eligible people must submit proof of their status, such as enrollment in Medicaid or participation in food assistance programs, to their local postmaster. The law requires the United States Postal Service to issue regulations for this program within a year and authorizes the agency to buy and maintain the necessary boxes. To cover the cost of lost rental fees and the expense of providing these boxes, the bill directs Congress to appropriate funds to the Postal Service annually. The Postmaster General must also submit an implementation plan within six months and provide progress reports every five years to Congress.
The Medicaid Dental Benefit Act of 2026 mandates that Medicaid programs cover a range of dental and oral health services for adults starting in 2027, including dentures, implants, and treatments for pain and emergencies. To help states afford this expansion, the bill provides 100 percent federal funding for these specific services for a 12-quarter period beginning in 2027, while allowing states the option to add extra dental benefits if they choose. In addition to expanding coverage, the legislation requires the federal government to develop standardized quality measures to track adult oral health outcomes and report on disparities based on race, ethnicity, and other demographics. The bill also directs the creation of an outreach program to help eligible adults find care and establishes a timeline for a comprehensive report on access barriers and reimbursement issues.
The Childhood Disability Benefits Fairness Act changes how Medicaid eligibility is determined for children who receive Social Security child's insurance benefits. Under current rules, these children might be denied Medicaid because their Social Security payments count as income, even though the payments are meant to replace lost wages due to a parent's disability. This bill ensures that children in this situation are treated as if they are receiving Supplemental Security Income benefits instead, which allows them to qualify for Medicaid regardless of their Social Security income. The change applies to all new eligibility decisions made after the law is passed, aiming to provide consistent access to healthcare coverage for disabled children with low family incomes.
The CHARTS Act authorizes $5 million over two years to provide grants to long-term care and post-acute care providers, such as nursing facilities and home health agencies, for implementing specific health information technology systems. These funds, capped at $500,000 per provider, must be used to develop tools that enable real-time data sharing among doctors, insurers, and government programs while improving care coordination and reducing duplicate services. The Department of Health and Human Services will prioritize grants for facilities serving Medicare and Medicaid beneficiaries and will ensure recipients represent a diverse range of geographic and demographic populations. Additionally, the bill requires the agency to submit reports evaluating how these technologies impact patient outcomes, costs, and care transitions over a six-year period.
The PREVENT ESRD Act establishes a ten-year demonstration program to help prevent kidney disease from progressing to end-stage renal disease, which places a heavy financial burden on Medicare. Starting in 2027, the program invites private health plans, Medicaid programs, and other insurers to voluntarily join an initiative where they must cover specific kidney care services, such as screenings, medications, and nutrition support, with little to no cost to patients. Participating plans can earn shared savings payments from Medicare if they successfully reduce the rate of kidney disease progression compared to a benchmark based on their historical data, provided they maintain high quality of care and do not avoid enrolling high-risk patients. The legislation also requires the Department of Health and Human Services to hold listening sessions and gather public input to refine the program's scope and ensure it meets the needs of patients and providers.
The MOMMIES Act expands Medicaid and CHIP coverage for low-income pregnant and postpartum individuals by extending continuous benefits for one year after childbirth and mandating full coverage of oral health services. To support these changes, the bill includes maintenance of effort provisions that prevent states from restricting eligibility or reducing benefits for this population, alongside a temporary 100 percent federal funding match for states that increase spending on these services. Additionally, the legislation establishes a five-year demonstration project to fund maternity care home models that integrate medical and social support services, while also requiring studies and guidance on improving access to doula services and telehealth for maternity care.
This bill requires Medicaid to cover applied behavior analysis therapy provided during school hours for students in grades kindergarten through twelfth who have an autism spectrum disorder. The therapy must be delivered in public or non-public schools, and the specific definitions for the treatment and therapy will follow existing state insurance law. By adding this coverage to Medicaid, the legislation ensures that eligible students can access this support within their educational setting without additional out-of-pocket costs. The changes will take effect approximately 90 days after the bill is signed into law.
Relates to adaptive aquatic safety services for individuals with disabilities; directs the commissioner of health to evaluate and seek approval for the inclusion of adaptive aquatic safety services as an available service component under applicable Medicaid home and community-based services authorities; relates to adaptive aquatic accessibility at state-funded public aquatic facilities; directs the commissioner of health to promulgate regulations requiring lifeguard certification and recertification courses to include instruction concerning aquatic safety for individuals with disabilities; authorizes school districts and boards of cooperative educational services to incorporate adaptive aquatic safety goals into individualized education programs where appropriate to address certain skills.
This bill establishes a minimum reimbursement standard for pharmacies that are not classified as critical access care facilities, requiring Medicaid managed care organizations to pay at least the same rates as the traditional fee-for-service program. The law mandates that these payments cover both the professional dispensing fee and the acquisition cost of the medication, regardless of whether the managed care organization pays the pharmacy directly or uses a third-party pharmacy benefit manager. Additionally, the bill directs the state Department of Healthcare Finance to implement various cost-control measures, such as limiting the number of prescriptions for certain drugs within a 30-day period and requiring prior approval for specific high-cost medications.
