Sponsor
Madeleine Dean
Representative · D-PA
Representative · D-PA
The bill expands no-cost coverage for OUD medications, behavioral health, residential treatment, and recovery supports across Medicare, Medicaid (with state opt-in), and private plans—improving access and retention for people with OUD—while increasing federal and private-sector costs, producing state-by-state variability, and risking capacity and implementation challenges during the pilot and temporary funding period.
Medicare beneficiaries in the targeted model states face no Part B/D (or Part C-applied) coinsurance, copays, or deductibles for OUD medications, behavioral health, licensed non-hospital residential addiction treatment, and recovery supports, substantially lowering out-of-pocket costs and improving treatment access.
People with opioid use disorder in group and individual commercial plans get standardized no-cost-sharing coverage for OUD medications, overdose-reversal drugs, behavioral health, residential treatment, and recovery supports (effective for plan years starting Jan 1, 2027), reducing financial barriers across the private market.
States receive an elevated 90% FMAP for Medicaid-covered MAT expenditures during the applicable PHE period, increasing federal funding that can expand MAT capacity and support state treatment programs.
Eliminating cost-sharing for treatments and services and raising Medicaid FMAP will increase federal and Medicare program spending, adding costs for taxpayers and pressuring federal budgets.
Insurers and employers may face higher costs from mandatory no-cost-sharing coverage, which could lead to higher premiums, increased employer contributions, and added administrative compliance burdens—especially for small and tax-exempt employers.
Beneficiaries in many states will have unequal access because the Medicare model is limited to 15 states and Medicaid inclusion of recovery support services is optional at the state level, leaving many Medicaid and Medicare enrollees without these reduced-cost services during the model period.
Based on analysis of 4 sections of legislative text.
Removes cost‑sharing for opioid drugs, behavioral health, and recovery supports in Medicare demo and private plans, expands Medicaid MAT to include recovery supports, and provides temporary 90% FMAP for MAT.
Official title: To promote affordable access to evidence-based opioid treatments under the Medicare program and require coverage of medication assisted treatment for opioid use disorders, opioid overdose reversal medications, and recovery support services by health plans without cost-sharing requirements.
Introduced September 3, 2026 by Madeleine Dean · Last progress September 3, 2026
Eliminates copayments, coinsurance, and deductibles for medications, behavioral health, and recovery support services for opioid use disorder across Medicare, private group and individual plans, and expands Medicaid coverage options. It also creates a Medicare CMI demonstration focused on high-need states and provides a temporary enhanced federal matching rate for medication‑assisted treatment during the public health emergency. The bill requires private group and individual health plans to cover opioid drugs, behavioral health treatment (including licensed non‑hospital residential treatment), and recovery support services without cost‑sharing beginning with plan years on or after January 1, 2027; expands the optional Medicaid definition of MAT to include recovery supports and provides a 90% FMAP for MAT spending during the portion of the public health emergency that begins on enactment; and directs a Medicare model to eliminate Part B/D (and Part C) cost‑sharing in selected states for opioid treatment and recovery services for an initial five‑year protected period.