The STOP FRAUD in Medicaid Act expands the scope of Medicaid fraud investigations by directing state Medicaid fraud control units to examine not just providers but also individuals who apply for or receive benefits. This change requires states to investigate and prosecute fraudulent activities involving both healthcare providers and beneficiaries seeking or receiving Medicaid coverage. The bill amends existing federal law to explicitly include individuals in the definition of entities subject to fraud control unit oversight. These provisions take effect 180 days after the law is enacted, giving states time to adjust their investigation procedures.
This bill would allow certain oral contraceptive drugs to be sold over-the-counter to adults aged 18 and older by requiring the FDA to prioritize their review and waive associated application fees. It specifically excludes emergency contraceptives and drugs also approved for induced abortion from these provisions. The legislation also directs the Government Accountability Office to study how federal programs fund contraception over the past 15 years, covering Medicare, Medicaid, and other health services.
This bill, known as the Diabetes Foot Health Access and Modernization Act of 2026, makes two main changes to federal health insurance programs. First, it allows podiatric physicians to provide covered physician services under Medicaid, ensuring patients have access to specialized foot and ankle care. Second, it updates Medicare rules to clarify documentation requirements for diabetic shoes, specifying that a physician must confirm a patient has diabetes and related foot conditions before these shoes are covered. The changes take effect on January 1, 2026 for Medicaid podiatry services and January 1, 2028 for Medicare diabetic shoe documentation.
This bill, the PrEP Access and Coverage Act of 2026, requires most health insurance plans to cover HIV prevention medication without charging patients any cost-sharing fees. It directly affects people enrolled in private insurance, Medicare, Medicaid, and other government health programs by mandating that these plans cover the medication, related lab tests, and follow-up care without requiring prior approval. The law also prohibits insurance companies from denying life, disability, or long-term care insurance to individuals taking HIV prevention medication and requires a public education campaign to increase awareness about the medication.
This bill requires the Secretary of Health and Human Services to create a two-year demonstration program that would make certain wound care treatments mandatory for Medicaid coverage for people with epidermolysis bullosa. The program would include over-the-counter medications, antiseptics, antibiotic ointments, and specific wound care supplies such as dressings and bandages. It would operate nationwide and require states to include these items and services in their Medicaid plans or waivers. At the end of the program, the Secretary must submit a report to Congress evaluating the program's impact on treatment costs and health outcomes, along with recommendations on preventing hospitalizations.
This bill, known as the Diabetes Foot Health Access and Modernization Act of 2026, makes two main changes to federal healthcare programs. First, it allows Medicaid to cover foot and ankle care services provided by podiatric physicians, ensuring patients have access to this specialized care. Second, it updates Medicare rules to clarify documentation requirements for diabetic shoes, specifying conditions under which patients can receive extra-depth or custom-molded footwear. The changes take effect on January 1, 2026, for Medicaid services and January 1, 2028, for Medicare shoe coverage.
This bill, titled the Combating Deceptive Practices in Assistance Programs Act of 2026, modifies Medicaid eligibility requirements for personal care services. It directly affects individuals seeking assistance with daily living activities under the Medicaid program. The key provision adds a specific eligibility criterion requiring applicants to be unable to perform at least three activities of daily living as defined in the Internal Revenue Code. These changes would take effect for medical assistance provided on or after January 12, 2027.
This bill, known as the State Veterans Homes Inspection Simplification Act, would allow certain State Veterans Homes that are already certified by the Department of Veterans Affairs to be automatically considered compliant with Medicare and Medicaid nursing home standards. Under this proposal, facilities meeting specific VA inspection and certification requirements would not need to undergo separate reviews by the Centers for Medicare & Medicaid Services, reducing duplication of effort. The legislation maintains oversight by requiring the VA to submit its inspection standards for review every two years, allowing CMS to conduct targeted surveys or complaints investigations, and mandating public reporting of inspection data on the Nursing Home Care Compare website. A Government Accountability Office report would be required three years after enactment to evaluate the bill's impact on survey efficiency, enforcement outcomes, and resident care quality.
Medicaid Personal Needs Allowance Modernization Act or the Medicaid PNA Modernization Act This bill increases the minimum monthly personal needs allowance under Medicaid for an institutionalized individual and couple from $30 to $60 and from $60 to $120, respectively. (The personal needs allowance is deducted from an individual's total income when determining the individual's contribution to the cost of institutionalized care under Medicaid.)
This bill would allow children in foster care who are placed in qualified residential treatment programs to receive Medicaid coverage for their medical services. It directly affects state child welfare systems and healthcare providers by removing a federal exclusion that currently prevents Medicaid from covering institutional care for these children. The law amends the Social Security Act to exempt these children from the Medicaid Institutional Medicaid Days (IMD) exclusion, which typically denies coverage for services provided in institutions. The change would take effect for services provided on or after October 1, 2026, ensuring continuity of healthcare coverage for this vulnerable population.
