Healthcare (Medicaid)

in committee · United States · House Oct 3, 2025

HR 5685: PNA Modernization Act

HR 5685, the PNA Modernization Act, increases the minimum monthly cash allowance under Medicaid for people living in long-term care facilities. It raises the individual allowance from $30 to $60 per month (effective January 2026) and the couple allowance from $60 to $120 per month. The bill also includes an automatic adjustment mechanism: starting after November 2025, these allowances will increase by the same percentage as Social Security benefit adjustments. This directly affects Medicaid beneficiaries residing in nursing homes or similar institutions, providing them with higher guaranteed personal spending funds.

Topics ✓ HealthcareSupports HealthcareIncreases Medicaid long-term care allowances, expanding financial support for beneficiaries under a public healthcare program.95% confidence

Sub-Topics Long-Term Care Medicaid

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in committee · United States · House Mar 27, 2025

HR 2477: Portable Ultrasound Reimbursement Equity Act of 2025

HR 2477, the Portable Ultrasound Reimbursement Equity Act of 2025, would amend Medicare rules to require equal reimbursement for portable ultrasound transportation and setup services as is currently provided for portable X-ray services. This change directly affects Medicare beneficiaries needing portable ultrasound exams and healthcare providers (like mobile clinics) who offer these services. The bill mandates that Medicare pay separately for portable ultrasound transportation and setup in the same way and to the same extent as portable X-ray services, using similar supplier requirements as existing regulations. The policy change would take effect for services provided on or after January 1, 2027.

Topics ✓ HealthcareSupports HealthcareBill mandates equal Medicare reimbursement for portable ultrasound services, improving access for beneficiaries and providers by correcting a disparity in coverage for similar medical services.95% confidence

Sub-Topics Medicaid Medicare Telehealth

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in committee · United States · Senate Jan 23, 2025

S 229: DTC Act of 2025

The DTC Act of 2025 requires pharmaceutical companies to disclose the wholesale acquisition cost (WAC) for a 30-day supply (or typical treatment course) of prescription drugs in direct-to-consumer advertisements. This applies to drugs covered by Medicare or Medicaid, excluding those with a WAC under $35 per 30-day supply. The bill mandates clear, conspicuous display of the WAC in ads, along with a note that actual patient costs may vary based on insurance coverage. It takes effect July 1, 2026, and includes penalties for noncompliance, such as civil fines up to $100,000 per violation. The law aims to increase price transparency for consumers seeing drug ads, particularly affecting patients with high-deductible plans or Medicare beneficiaries.

Topics ✓ HealthcareSupports HealthcareMandates transparency in drug pricing for Medicare/Medicaid drugs via WAC disclosure in ads, improving patient cost awareness and aligning with healthcare transparency goals.90% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · United States · House Nov 20, 2025

HR 6242: Healthy MOM Act

The Healthy MOM Act (HR 6242) would require health insurance plans to provide a special enrollment period for pregnant individuals beginning when pregnancy is reported to the insurer. It mandates that group health plans and health insurance issuers cover maternity care, including childbirth and postpartum care, for all dependents regardless of age. The bill would extend Medicaid coverage for pregnant individuals and infants to 12 months postpartum (instead of ending at 60 days postpartum) and make this 12-month coverage permanent. These provisions would directly affect pregnant individuals, women with dependent children who are pregnant, and health insurance plans and Medicaid programs.

Topics ✓ HealthcareSupports HealthcareMandates maternity coverage, extends Medicaid postpartum from 60 to 12 months, expands access for pregnant individuals and infants95% confidence

Sub-Topics Insurance Medicaid Women's Health

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in committee · United States · House Feb 4, 2025

HR 950: Saving Seniors Money on Prescriptions Act

HR 950, the Saving Seniors Money on Prescriptions Act, requires pharmacy benefit managers (PBMs) working with Medicare Part D prescription drug plans to provide detailed annual reports starting in 2028. These reports must include transparent information about drug pricing, rebates, out-of-pocket costs for beneficiaries, and how brand-name drugs compare to generic alternatives. The bill specifically targets PBMs' relationships with affiliated pharmacies and requires them to disclose how their contracts affect drug costs for Medicare beneficiaries. It also mandates an annual report from the Government Accountability Office (GAO) to assess and streamline existing reporting requirements for health plans and PBMs. The goal is to increase transparency around prescription drug pricing in Medicare plans to help seniors understand and potentially reduce their medication costs.

Topics ✓ HealthcareSupports HealthcareRequires PBMs to disclose drug pricing/rebates for Medicare Part D, improving transparency and reducing out-of-pocket costs for seniors, directly enhancing patient access to affordable prescriptions.95% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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in committee · United States · House Sep 9, 2025

HR 5228: HCBS Worker Protection Act of 2025

This bill amends the Social Security Act to remove a payment limitation for certain Medicaid Home and Community-Based Services (HCBS) waivers. Specifically, it strikes a provision (subparagraph (C) of Section 1915(c)(11)) that restricted how states could fund these waivers under Medicaid. The change directly affects state Medicaid programs that use HCBS waivers to provide home and community care for people with disabilities or elderly individuals. By removing this restriction, states gain more flexibility in allocating Medicaid funds for these services, without altering eligibility or service requirements.

Topics ✓ HealthcareSupports HealthcareRemoves Medicaid HCBS waiver payment restriction, expanding access to home/community care for disabled/elderly individuals, directly strengthening healthcare access and coverage.90% confidence

Sub-Topics Long-Term Care Medicaid Tags People with Disabilities

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in committee · United States · House Mar 6, 2025

HR 1931: Access to Pediatric Technologies Act of 2025

This bill creates a process for establishing Medicare payment rates for pediatric-specific medical devices. It requires the Medicare program (via the Secretary of Health and Human Services) to set national payment rates (called "relative value units") for qualifying pediatric technologies upon manufacturer request, starting in 2026. A "qualifying pediatric technology" is defined as a covered medical device that is FDA-approved/cleared, has a temporary HCPCS code, and is either predominantly used for pediatric procedures or specifically designed for children. Manufacturers must submit detailed data with their requests, and the timeline for setting rates depends on when the request is received (by May 1 for same-year implementation). The bill does not mandate coverage but ensures payment mechanisms exist for these devices once approved.

Topics ✓ HealthcareSupports HealthcareBill establishes Medicare payment rates for pediatric devices, improving access to covered medical services under public health insurance program.95% confidence

Sub-Topics Children's Health Medicaid Medicare

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in committee · United States · House Mar 11, 2025

HR 2082: WISH Act

The WISH Act would create a federal long-term care insurance program to help seniors cover costs of long-term care services. It would provide monthly benefits to seniors who have a serious disability lasting at least a year, have met coverage requirements (6 quarters of coverage in the base period starting in 2026), and have not exhausted their savings. Benefits would be calculated based on the median cost of personal assistance care and the individual's work history. The program would be funded through an initial $12 million appropriation for each of fiscal years 2026-2028, plus $50 million for public education. This would help seniors avoid exhausting their savings or becoming dependent on Medicaid for long-term care costs.

Topics ✓ Budget & TaxesSupports Budget & TaxesCreates federal long-term care program requiring government funding for senior benefits, aligning with funding essential public services.92% confidence ✓ HealthcareSupports HealthcareCreates federal long-term care insurance program expanding coverage for seniors' care costs, directly advancing healthcare access and funding under healthcare policy.95% confidence

Sub-Topics Appropriations Long-Term Care Medicaid Tags Seniors

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in committee · United States · House Feb 6, 2025

HR 1059: Jobs and Opportunities for Medicaid Act

The Jobs and Opportunities for Medicaid Act would require most Medicaid recipients aged 18 to 65 to work or volunteer at least 20 hours per week (averaged monthly) to maintain health coverage, starting January 1, 2026. Exemptions include individuals who are pregnant, primary caregivers for children under 6, medically unable to work, or enrolled in substance abuse treatment programs. States would need to verify each month whether recipients meet this work requirement to continue receiving Medicaid benefits.

Topics ✗ HealthcareOpposes HealthcareImposes work requirement on Medicaid recipients, restricting access to coverage for non-exempt individuals per bill's core provision90% confidence

Sub-Topics Medicaid Substance Abuse

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in committee · United States · House Jun 25, 2026

HR 5243: To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.

This bill requires Medicare Advantage (MA) plans to report detailed, individual-level data on supplemental benefits (like dental or vision coverage) starting in 2029. Plans must submit information on eligibility, benefit types, utilization, and costs per enrollee to the Centers for Medicare & Medicaid Services (CMS). Beginning in 2030, CMS must publish this data annually on its website for public research and program evaluation, while protecting individual privacy. The law aims to improve transparency around supplemental benefits without changing the benefits themselves.

Topics ✓ HealthcareSupports HealthcareRequires Medicare Advantage plans to report supplemental benefits data for public research, improving program evaluation and transparency in healthcare services.85% confidence

Sub-Topics Medicaid Medicare

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