Sponsors (31)
The bill expands and protects Medicaid coverage and reduces financial barriers for people diagnosed with breast or cervical cancer—improving access and post-surgical care—while increasing state Medicaid costs and imposing short-term administrative and implementation challenges.
Medicaid beneficiaries diagnosed with breast or cervical cancer (primarily women) will gain mandatory Medicaid eligibility so they have continuous coverage for diagnosis and treatment.
People who undergo medically necessary mastectomy (Medicaid enrollees) will have breast reconstruction covered, improving post-surgical care, recovery, and quality of life.
Low-income Medicaid patients diagnosed with these cancers will face no enrollment fees, premiums, or cost-sharing for the covered services, reducing out-of-pocket barriers to getting timely care.
State governments (and ultimately taxpayers) may incur higher Medicaid costs to cover the newly mandatory population and reconstruction services, adding pressure to state budgets.
Hospitals, health systems, and state Medicaid agencies may face short-term administrative burdens (network changes, updated prior-authorization rules, claims/process updates) to implement the new coverage requirements.
Medicaid beneficiaries could experience delays in accessing covered services during the 1-year phase-in if federal matching limits or implementation guidance are unclear, temporarily harming timely care.
Based on analysis of 2 sections of legislative text.
Makes people with breast or cervical cancer a mandatory Medicaid eligibility group and requires Medicaid coverage of breast reconstruction after medically necessary mastectomy.
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 to treat people with breast or cervical cancer as a mandatory eligibility group and adds coverage of breast reconstruction after medically necessary mastectomy as a Medicaid benefit. The bill updates cross-references, extends prohibitions on enrollment fees/premiums and cost-sharing to this population, and takes effect one year after enactment.