Sponsors (30)
The bill expands and clarifies Medicaid coverage for breast and cervical cancer care — including reconstruction after mastectomy — improving access for affected patients, but it raises state costs, may expose some enrollees to cost-sharing, and delays implementation by one year.
Medicaid enrollees diagnosed with breast or cervical cancer will gain explicit Medicaid eligibility and coverage for cancer-related care, improving access to diagnosis, treatment, and related services.
Women who undergo medically necessary mastectomy will have Medicaid coverage for breast reconstruction, ensuring reconstructive surgery is available without a separate coverage gap.
States and beneficiaries get clearer federal funding (FMAP) and cost-sharing rules, which helps state governments administer benefits and helps enrollees understand payment responsibilities.
State governments (and potentially state taxpayers) may face higher Medicaid costs from expanded eligibility and mandated reconstruction coverage, creating budgetary pressure or trade-offs with other state priorities.
Some Medicaid enrollees could face new copayments or cost-sharing if exemptions are not applied, which may reduce affordability and deter care for low-income patients.
A one-year delay before the provisions take effect postpones benefits and could prolong gaps in coverage or reconstruction access for patients who need immediate care.
Based on analysis of 2 sections of legislative text.
Requires Medicaid to include certain people with breast or cervical cancer as an eligibility category and to cover breast reconstruction after a medically necessary mastectomy.
Introduced July 17, 2025 by Maxine Waters · Last progress July 17, 2025
Requires Medicaid to treat certain people with breast or cervical cancer as an eligible group and explicitly makes breast reconstruction after a medically necessary mastectomy a covered Medicaid service. The change also updates Medicaid matching and cost-sharing cross-references so federal FMAP and cost-sharing rules apply to the new eligibility group, and it takes effect one year after enactment.