Sponsors (30)
The bill expands Medicaid coverage and eliminates cost-sharing for women diagnosed with breast or cervical cancer — improving access and post-mastectomy reconstruction care — while increasing state Medicaid costs and requiring administrative changes that could cause short-term delays.
Medicaid beneficiaries diagnosed with breast or cervical cancer (primarily women) are made mandatorily eligible for Medicaid, ensuring continuous coverage for diagnosis and treatment.
Medicaid will cover breast reconstruction after medically necessary mastectomy, improving post-surgical care and quality of life for affected patients.
Low-income people in this new eligibility group face no enrollment fees, premiums, or cost‑sharing for these services, reducing out-of-pocket barriers to cancer care.
State governments (and ultimately taxpayers) may face higher Medicaid costs to cover the newly mandatory population and reconstruction services, increasing state budget pressure.
Medicaid beneficiaries (women) could experience delays in access to coverage or services during the one-year phase-in if federal match limits or implementation guidance are unclear.
Some states, hospitals, and health systems may incur short-term administrative burdens to update provider networks, prior-authorization rules, and billing systems to implement reconstruction coverage.
Based on analysis of 2 sections of legislative text.
Makes people with breast or cervical cancer a mandatory Medicaid eligibility group and adds breast reconstruction after medically necessary mastectomy as a covered Medicaid benefit.
Official title: To amend title XIX of the Social Security Act to require coverage for certain individual with breast or cervical cancer under the Medicaid program.
Introduced July 17, 2025 by Maxine Waters · Last progress July 17, 2025
Requires Medicaid programs to treat people with breast or cervical cancer as a mandatory eligibility group and adds coverage for breast reconstruction following medically necessary mastectomy. Updates Medicaid benefit and cost-sharing rules and cross-references so the new group is protected from premiums, enrollment fees, and most cost-sharing. Makes those changes to federal Medicaid statute and sets the changes to take effect one year after the law is enacted.