H.R. 4543

119th CONGRESS 1st Session

To amend title XIX of the Social Security Act to require coverage for certain individual with breast or cervical cancer under the Medicaid program.

IN THE HOUSE OF REPRESENTATIVES · July 17, 2025 · Sponsor: Ms. Waters · Committee: Committee on Energy and Commerce

Table of contents

• H.R. 4543
  • SEC. 1. Short title
  • SEC. 2. Requiring Medicaid coverage for certain individuals with breast or cervical cancer under the Medicaid program

SEC. 1. Short title

• This Act may be cited as the Medicaid Breast Cancer Access to Treatment Act.

SEC. 2. Requiring Medicaid coverage for certain individuals with breast or cervical cancer under the Medicaid program

• (a) In general
  • Section 1902 of the Social Security Act () is amended— 42 U.S.C. 1396a
    • in subsection (a)(10)—
      • in subparagraph (A)—
        • (i) in the matter preceding clause (i), by striking and (30)and inserting (30), and (32);
        • (ii) in clause (i)—
        • in subclause (VIII), by striking or at the end;
        • in subclause (IX), by adding at the end; and or
          • who are described in subsection (aa) (relating to certain breast or cervical cancer patients);
        • by adding at the end the following new subclause:
        • (iii) in clause (ii), by striking subclause (XVIII); and
      • in the matter at the end, in subdivision (XIV), by striking subparagraph (A)(10)(ii)(XVIII)and inserting subparagraph (A)(10)(i)(X); and
    • in subsection (aa)—
      • by striking paragraphs (1) and (2);
      • by redesignating paragraphs (3) and (4) as paragraphs (1) and (2), respectively; and
      • in paragraph (2), as so redesignated, by inserting after .
• (b) Inclusion of breast reconstruction as medical assistance
  • Section 1905(a) of the Social Security Act () is amended— 42 U.S.C. 1396d(a)
    • in paragraph (31), by striking and at the end;
    • by redesignating paragraph (32) as paragraph (33); and
      • breast reconstruction following a medically necessary mastectomy; and
    • by inserting after paragraph (31) the following new paragraph:
• (c) Conforming amendments
  • (1) FMAP
    • Section 1905(b)(4) of the Social Security Act () is amended by striking section 1902(a)(10)(A)(ii)(XVIII)and inserting section 1902(a)(10)(A)(i)(X). 42 U.S.C. 1396d(b)(4)
  • (2) Cost sharing
    • (A) In general
      • Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act () are each amended— 42 U.S.C. 1396o
        • (i) in subparagraph (I), by striking or at the end;
        • (ii) in subparagraph (J), by striking at the end and inserting , or; and
        • (iii) by adding at the end the following new subparagraph:
          • items and services furnished to individuals described in section 1902(aa); and
    • (B) Alternative cost sharing
      • Section 1916A(b)(3) of the Social Security Act () is amended— 42 U.S.C. 1396o–1(b)(3)
        • (i) in subparagraph (A)(v), by striking 1902(a)(10)(A)(ii)(XVIII)and inserting 1902(a)(10)(A)(i)(X); and
        • (ii) in subparagraph (B)(viii), by striking 1902(a)(10)(A)(ii)(XVIII)and inserting 1902(a)(10)(A)(i)(X).
• (d) Effective date
  • The amendments made by this section shall apply beginning 1 year after the date of the enactment of this Act.