Sponsors (6)
The bill substantially lowers financial barriers and incentives for states to expand evidence-based OUD treatment and recovery supports—likely improving access and reducing overdoses—at the cost of sizable federal/state spending increases, potential geographic gaps, provider capacity strains, and transitional administrative burdens.
Medicare beneficiaries, Medicaid enrollees, and people with opioid use disorder (including low-income, rural, and other affected patients) face much lower out-of-pocket costs for FDA-approved OUD medications, overdose-reversal drugs, behavioral health treatment, and non-hospital residential care, removing a major financial barrier to treatment.
People receiving medication-assisted treatment will gain covered recovery supports (peer counseling, transportation and similar nonclinical services), improving treatment retention and recovery outcomes.
States can get a permanent optional 90% federal Medicaid match for covering MAT and recovery services, substantially lowering state fiscal barriers to expanding access to these services.
Federal taxpayers and the Medicare/Medicaid programs will face higher spending from eliminating cost-sharing and offering a 90% FMAP for MAT/recovery services, increasing the fiscal cost of federal health programs.
Beneficiaries in nonselected States (and people in States that do not adopt optional Medicaid recovery coverage) will face geographic inequities in access and affordability of OUD services.
Expanded demand for non-hospital residential treatment and recovery services may exceed provider capacity—especially in rural areas—producing waitlists and limiting timely access despite waived cost-sharing.
Based on analysis of 4 sections of legislative text.
Introduced June 12, 2025 by Richard Blumenthal · Last progress June 12, 2025
Eliminates cost-sharing for a set of opioid use disorder (OUD) treatments and recovery services in several federal programs and markets, creates a Medicare Innovation Center demonstration to test no-cost-sharing access in 15 selected States, and provides a permanent optional 90% Medicaid matching rate for medication‑assisted treatment (MAT) expenditures. Group and individual market plans and ERISA-covered group plans must cover specified drugs, behavioral health services (including non-hospital residential treatment), and recovery supports without copays, coinsurance, or deductibles beginning with plan years on or after January 1, 2027. States may opt to include recovery support services as part of Medicaid MAT and receive enhanced federal funding for MAT spending starting on the date of enactment.