Healthcare (Medicaid)

This bill removes marriage restrictions that previously caused Disabled Adult Children (DACs) to lose Social Security disability benefits upon marriage. It amends Social Security rules to treat married DACs the same as unmarried ones for eligibility, ensuring they retain benefits for child's insurance based on a disability. Key provisions prevent states from counting a spouse's income/resources against a married DAC and guarantee Medicaid eligibility remains unchanged if the DAC would qualify as unmarried. The bill directly affects DACs receiving Social Security Disability Insurance (SSDI) through a parent's account who are married, ensuring they maintain access to Medicare, Medicaid, and SSDI benefits without geographic or marital status barriers.

Lower Costs for Everyday Americans Act This bill reauthorizes and establishes programs and requirements regarding health, commerce, and the environment. The bill reauthorizes and expands programs for health care, including by allowing individuals age 65 and over with a medically improved disability to qualify for Medicaid; extending payment increases for certain providers under Medicare, including physicians and rural hospitals;  extending Medicare coverage of certain telehealth services; requiring pharmacy benefit managers to remit 100% of rebates for prescription drugs to group health plans;  reauthorizing programs supporting health care in underserved communities, including the National Health Service Corps; expanding and reauthorizing programs for public health emergency preparedness and response, including pandemic preparedness;  expanding and reauthorizing programs for prevention and treatment of certain conditions, including substance use disorders, traumatic brain injuries, and sickle cell disease; and expanding the Food and Drug Administration’s authority regarding research on rare pediatric diseases. The bill also establishes requirements relating to commerce, including by  prohibiting nonconsensual online publication of intimate visual depictions of individuals,  requiring manufacturers of internet-connected devices to disclose whether the device has a camera or microphone prior to purchase, banning products containing 10% or more of sodium nitrite by weight, and requiring additional disclosures relating to the prices of concert tickets and hotel rooms. Additionally, the bill establishes and reauthorizes programs relating to the environment, including grants for community recycling systems, drinking water infrastructure, and reducing diesel emissions. It also allows gasoline that is blended with 10% to 15% ethanol to be sold year-round.

The Medicaid Program Improvement Act requires states to regularly verify and update the addresses of Medicaid and CHIP (Children's Health Insurance Program) enrollees using reliable data sources, starting January 1, 2026. States must act on any address changes obtained through these sources, ensuring records remain accurate. Managed care organizations contracting with states must also transmit address information they receive directly from enrollees to the state. This applies to all 50 states and the District of Columbia, aiming to improve data accuracy for program administration.

The Ensuring Medicaid Eligibility Act of 2025 prohibits the implementation of a 2024 rule that would have streamlined Medicaid application and enrollment processes. It requires states to verify U.S. citizenship or immigration status before enrolling individuals in Medicaid and mandates quarterly verification of income-based eligibility for those relying on income calculations. The bill also blocks federal funding for Medicaid coverage for certain non-citizens, including parolees, Temporary Protected Status (TPS) recipients, Deferred Action for Childhood Arrivals (DACA) recipients, asylum seekers, and individuals granted withholding of removal. These provisions directly affect non-citizen Medicaid applicants and require states to adjust enrollment and verification procedures.

This bill automatically qualifies certain Medicaid beneficiaries for Medicare Part D prescription drug subsidies when they turn 65. Specifically, it treats individuals enrolled in Medicaid under specific state plan provisions (as defined in Section 1902(a)(10)(A)) with income below 200% of the poverty line as "subsidy eligible" for Part D, without requiring additional application. The provision applies to those who were enrolled in Medicaid the day before turning 65, and the subsidy period is limited as determined by the Secretary. It takes effect for Medicare plan years beginning January 1, 2027. The bill does not change drug pricing but streamlines access to existing subsidy programs for this group.

HR 1901, the CHIPP Act, makes Children's Health Insurance Program (CHIP) funding permanent for all future fiscal years, removing previous expiration dates that required annual congressional renewal. This directly affects low-income children and families who rely on CHIP coverage and the states that administer these programs. The key mechanism is amending federal law to require "such sums as are necessary" for CHIP funding starting in fiscal year 2029 and beyond. Other provisions adjust funding for related programs like pediatric quality measures and outreach, but the primary change is CHIP’s permanent funding structure.

HR 922, the Period PROUD Act of 2025, allocates $1.9 billion annually (2025-2028) through the Social Services Block Grant Program, with $200 million specifically dedicated each year (2026-2029) to provide free menstrual products to low-income menstruating individuals. It requires states to distribute these funds to eligible nonprofits with experience in community distribution of basic needs, integrating the program with existing services like SNAP, Medicaid, and WIC. The bill mandates that funds supplement, not replace, other existing programs, prohibits limiting where products can be distributed, and caps administrative costs at 9% of allocated funds. States must report annually and an evaluation of the program’s effectiveness will be completed by 2031.

HR 1921, the Hearing Device Coverage Clarification Act, requires Medicare to clarify that fully implanted active middle ear hearing devices are prosthetics - not excluded hearing aids - ensuring they qualify for coverage under Medicare's prosthetic benefit. This change directly affects Medicare beneficiaries, particularly seniors and individuals with hearing impairments who rely on these implanted devices. The bill mandates the Centers for Medicare & Medicaid Services (CMS) to issue this clarification within 60 days of enactment, using the existing federal definition of "prosthetic" from the Code of Federal Regulations. This policy adjustment removes an administrative barrier, allowing Medicare to cover these devices without requiring separate policy changes.

Radiation Oncology Case Rate Value Based Program Act of 2025 or the ROCR Value Based Program Act This bill establishes a specialized payment program under Medicare for providers and suppliers of radiation oncology services.  Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a program under which radiation therapy providers (i.e., hospital outpatient departments) and suppliers (i.e., physician group practices and freestanding radiation therapy centers) receive payments for each episode of care provided to individuals with specified types of cancer. An episode of care  means the period beginning on the day radiation therapy planning is furnished to the individual and ending (1) for individuals with bone or brain metastases, 30 days later; and (2) for individuals with other cancer types, 90 days later. Participation in the program is mandatory for providers and suppliers that participate in Medicare, unless the provider or supplier is part of a state-based Center for Medicare & Medicaid Innovation model or qualifies for a significant hardship exemption. The CMS must set payment rates for the program based on national payment rates with specified adjustments (e.g., geographic adjustments). Providers and suppliers who provide certain transportation services for individuals under their care may receive an additional payment. Providers and suppliers must be accredited in accordance with certain standards, subject to payment reductions. The Government Accountability Office must report on (1) implementation of the program, and (2) underserved areas that are in need of more or newer radiation therapy resources.

The Old Drugs, New Cures Act creates a new "priority research drug" designation for older medications being studied for new medical uses. It directly affects drug manufacturers who want to investigate existing drugs (approved over 10 years ago) for new indications addressing significant unmet medical needs, particularly for diseases affecting 33%+ of beneficiaries in federal health programs like Medicare, Medicaid, or VA care. Key provisions require the Secretary to designate such drugs within 60 days of a request, then exclude them from Medicaid and Medicare pricing rules that typically treat minor drug modifications as "line extensions." This exclusion allows manufacturers to potentially secure better reimbursement for these repurposed drugs under current program rules. The bill changes how these specific drugs are classified in federal healthcare programs, not the drugs' medical use.