Healthcare (Medicaid)

in committee · United States · House Mar 5, 2025

HR 1875: Medicaid Provider Screening Accountability Act

HR 1875, the Medicaid Provider Screening Accountability Act, requires states to conduct monthly checks starting January 1, 2028, to verify if Medicaid providers or suppliers are still eligible to participate. It directly affects all healthcare providers and suppliers enrolled in Medicaid, including those seeking initial enrollment, renewal, or revalidation. The key provision mandates states to check federal and state databases (created under the Affordable Care Act) to confirm no termination of participation has occurred by the federal government or other states. This ensures providers remain compliant with federal and state participation rules throughout their enrollment period. The bill focuses on operational screening, not on reducing fraud or improving care outcomes.

Topics ✓ HealthcareSupports HealthcareMandates monthly eligibility checks for Medicaid providers, strengthening program integrity and preventing ineligible providers from participating in healthcare services.85% confidence

Sub-Topics Children's Health Insurance Medicaid

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in committee · United States · Senate Jun 2, 2025

S 1925: Expanding Access to Diabetes Self-Management Training Act of 2025

This bill expands Medicare coverage for diabetes self-management training for beneficiaries with diabetes. It requires 100% coverage with no cost-sharing for these services, including an initial 10 hours plus 2 additional hours annually, and allows physicians or qualified non-physician practitioners to authorize them. The bill also establishes a pilot program to test virtual training services starting in 2026, evaluating health outcomes and cost impacts. These changes apply to Medicare beneficiaries with diabetes beginning January 1, 2027.

Topics ✓ HealthcareSupports HealthcareBill expands Medicare coverage for diabetes self-management training with 100% coverage and no cost-sharing, improving patient access and strengthening insurance coverage for beneficiaries.95% confidence ✓ TechnologySupports TechnologyBill establishes pilot program for virtual training services, expanding digital health access and technology integration in Medicare diabetes care.75% confidence

Sub-Topics Medicaid Medicare

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in committee · United States · House May 23, 2025

HR 3581: Protect DSH Act

HR 3581, the Protect DSH Act, delays federal payment reductions for Disproportionate Share Hospitals (DSH) that serve high numbers of Medicaid and uninsured patients. It amends the Social Security Act to extend the timeline for these payment reductions from 2026-2028 to 2029-2031. The bill directly affects hospitals qualifying as DSH by postponing the scheduled decrease in federal funding. This change provides temporary financial stability for these healthcare providers without altering the underlying payment structure. The bill focuses on procedural timing, not policy changes to the DSH program itself.

Topics ✓ HealthcareSupports HealthcareDelays federal payment cuts for DSH hospitals serving Medicaid/uninsured patients, maintaining funding stability to protect healthcare access for vulnerable populations.95% confidence

Sub-Topics Hospitals Medicaid

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in committee · United States · Senate Jun 10, 2025

S 2008: Stop Funding Genital Mutilation Act

This bill prohibits federal Medicaid and CHIP funding for specific medical procedures related to gender transition, as defined in the legislation. It amends the Social Security Act to block funding for surgeries (like hysterectomy, phalloplasty, or mastectomy), hormone therapies (including puberty blockers or supraphysiologic doses), and certain cosmetic procedures when performed to change physical characteristics to align with a person's gender identity. Exceptions apply for medically necessary treatments, such as puberty suppression for precocious puberty, correction of disorders of sex development, or life-threatening conditions. The bill directly affects Medicaid/CHIP recipients seeking these covered procedures and requires states to exclude them from funded services. It does not ban the procedures themselves but restricts federal financial support for them.

Topics ✗ HealthcareOpposes HealthcareProhibits Medicaid/CHIP funding for gender transition procedures, restricting healthcare access and defunding specific treatments under healthcare programs.95% confidence

Sub-Topics Children's Health Medicaid

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in committee · United States · House Jul 14, 2025

HR 4384: Excluding Illegal Aliens from Medicaid Act

HR 4384, the "Excluding Illegal Aliens from Medicaid Act," accelerates the effective date for excluding undocumented immigrants (who are not qualified aliens and not children or pregnant women lawfully residing in the U.S.) from Medicaid eligibility from October 1, 2026, to July 4, 2025. The bill also establishes a higher federal funding rate for states that choose to provide health coverage to such individuals through state-funded programs, increasing federal support for these specific services. This change directly affects undocumented immigrants who do not qualify as "qualified aliens" under federal law and are not children or pregnant women, removing their Medicaid eligibility starting in 2025. States continuing to cover these individuals can do so via state programs with enhanced federal matching funds for that coverage.

Topics ✗ HealthcareOpposes HealthcareBill accelerates exclusion of undocumented immigrants from Medicaid eligibility, restricting health coverage for a specific group under public health programs.95% confidence ✗ ImmigrationOpposes ImmigrationExcludes undocumented immigrants from Medicaid eligibility, restricting access to health services per bill summary.95% confidence

Sub-Topics Medicaid DACA & Dreamers Enforcement Sanctuary Policies

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in committee · United States · Senate May 7, 2025

S 1637: MVP Act

Medicaid VBPs for Patients Act or the MVP Act This bill provides statutory authority for regulations that allow for the use of varying best price points under value-based purchasing arrangements for purposes of the Medicaid Drug Rebate Program. ( Value-based purchasing arrangements refer to arrangements in which the price of a drug is linked to clinical outcomes; such arrangements are particularly used for new high-cost treatments, such as gene therapies.) The Government Accountability Office must study the impact of value-based purchasing arrangements on federal health care programs, including with respect to the bill's changes. Additionally, the bill (1) exempts sales of drugs that are made under value-based purchasing arrangements from calculations of the manufacturer average sales price for purposes of payments under Medicare medical services, if the manufacturer reports multiple best prices under Medicaid in accordance with the bill's changes; and (2) requires the Centers for Medicare & Medicaid Services to issue guidance on how state Medicaid programs may cover drugs in inpatient settings via value-based purchasing arrangements.

Topics ✓ HealthcareSupports HealthcareEnables value-based drug pricing in Medicaid, linking costs to clinical outcomes to improve treatment effectiveness and access for high-cost therapies like gene therapies.90% confidence

Sub-Topics Medicaid Medicare Prescription Drugs

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in committee · United States · House Jul 21, 2025

HR 4569: Supporting Premature Infant Nutrition Act of 2025

This bill requires Medicaid, Children's Health Insurance Program (CHIP), and private health plans to cover human milk fortifier - specialized nutritional products made from donor human milk - without cost-sharing for eligible premature infants. It directly affects infants under 1 year with specific medical needs, such as birth at 34 weeks or less, birth weight under 1,800 grams, or certain health conditions requiring this fortifier. Key provisions mandate no deductibles or copays for this coverage starting January 1, 2026, and define eligibility criteria for healthcare providers to determine medical necessity. The law applies broadly across federal health programs and private insurance, ensuring access to this nutrition support for qualifying infants.

Topics ✓ HealthcareSupports HealthcareMandates no cost-sharing for human milk fortifier under Medicaid/CHIP, expanding essential nutrition access for premature infants with medical needs.95% confidence

Sub-Topics Children's Health Insurance Medicaid

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in committee · United States · House Sep 15, 2025

HR 5364: STOP FRAUD in Medicaid Act

HR 5364, the STOP FRAUD in Medicaid Act, expands state Medicaid fraud control units' authority to investigate and prosecute fraud committed by Medicaid beneficiaries (people receiving benefits), not just healthcare providers. It amends federal law to explicitly include "individuals applying for or receiving" Medicaid services in fraud investigations, requiring states to cover both provider and beneficiary fraud. The bill directs states to investigate false applications or misuse of benefits, such as lying about income to qualify or using benefits for unauthorized services. These changes take effect 180 days after the bill becomes law, applying to all Medicaid programs nationwide. The law focuses on clarifying investigative scope without creating new penalties or funding.

Topics ✓ HealthcareSupports HealthcareBill protects Medicaid program integrity by preventing beneficiary fraud, aligning with 'protect' indicator under healthcare support.85% confidence

Sub-Topics Medicaid

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in committee · United States · Senate Apr 1, 2025

S 1227: ABC Act

S 1227 (ABC Act) requires the Centers for Medicare & Medicaid Services and Social Security Administration to review and simplify eligibility processes, forms, and communications for Medicare, Medicaid, CHIP, and Social Security programs. It directly affects family caregivers - defined as individuals supporting people with disabilities or health needs - who often face duplicate paperwork and communication barriers when navigating these systems. Key provisions mandate reducing repeated information requests, improving website accessibility (including ADA compliance), cutting call wait times, providing translation services, and gathering input from caregivers and advocacy groups. The agencies must report findings and proposed improvements to Congress within two years, with follow-up reports every two years. This bill focuses on streamlining existing processes, not creating new benefits or funding.

Topics ✓ HealthcareSupports HealthcareBill simplifies Medicare/Medicaid eligibility processes, reduces duplicate paperwork for caregivers, and improves access to healthcare programs, directly advancing patient access and system efficiency.90% confidence

Sub-Topics Children's Health Medicaid Medicare

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in committee · United States · Senate Mar 12, 2025

S 983: Hearing Device Coverage Clarification Act

The Hearing Device Coverage Clarification Act (S 983) requires the Centers for Medicare & Medicaid Services (CMS) to clarify that implanted active middle ear hearing devices are prosthetics - not hearing aids - so they fall under Medicare's prosthetic coverage instead of the hearing aid exclusion. This change would directly affect Medicare beneficiaries who use these specific devices, ensuring they qualify for coverage without being denied under current policy. CMS must issue this clarification within 60 days of the bill's enactment, referencing the existing regulatory definition of "prosthetic" from 42 CFR § 414.202. The bill does not create new benefits but removes a coverage barrier for these devices.

Topics ✓ HealthcareSupports HealthcareBill expands Medicare coverage by reclassifying devices as prosthetics (not hearing aids), ensuring beneficiaries qualify for coverage they were previously denied under current policy.95% confidence

Sub-Topics Medicaid Medicare

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