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Adds a new mandatory Medicaid eligibility category for people diagnosed with breast or cervical cancer and requires Medicaid to cover breast reconstruction after a medically necessary mastectomy. The changes adjust related Medicaid benefit and cost-sharing rules and take effect one year after the law is enacted.
The bill extends guaranteed Medicaid coverage and lowers cost barriers for people with breast or cervical cancer (including reconstruction), improving care and financial protection for beneficiaries while increasing Medicaid costs and creating upfront state administrative burdens that may require budget tradeoffs.
Medicaid beneficiaries diagnosed with breast or cervical cancer (primarily women) gain mandatory Medicaid eligibility, increasing their access to continuous coverage and cancer care.
Medicaid beneficiaries who undergo medically necessary mastectomy will have coverage for breast reconstruction, improving post‑surgical recovery, quality of life, and access to reconstruction services.
Low‑income individuals eligible under the new category face reduced out‑of‑pocket costs because services/items for this group are treated as exempt from certain Medicaid cost‑sharing.
State governments and taxpayers will face increased Medicaid enrollment and service costs to cover the new eligibility group and reconstruction services, creating immediate fiscal pressure.
Expanded coverage raises federal and state Medicaid spending over time, which may force tradeoffs with other budget priorities or require future revenue adjustments affecting middle‑class families and taxpayers.
States, hospitals, and health systems may incur upfront administrative and IT costs to update eligibility, claims, and enrollment systems before the effective date, creating implementation burdens.
Introduced July 17, 2025 by Maxine Waters · Last progress July 17, 2025