Sponsors (4)
The bill expands no‑cost coverage of donor human milk‑derived fortifier for insured infants, improving clinical access and equity and lowering family costs, but could raise insurance and state program costs and its benefits may be limited by product supply constraints.
Infants under 1 covered by Medicaid, CHIP, or employer/individual plans gain no-cost access to donor human milk-derived fortifier when medically necessary starting Jan 1, 2026, improving clinical nutrition for vulnerable infants.
Families who need donor human milk-derived fortifier face reduced out-of-pocket expenses because cost-sharing is eliminated for covered infants.
Standardizing coverage across Medicaid, CHIP, and private plans increases equity of access so access does not depend on insurer or state.
Expanding mandated coverage may raise insurance plan costs and could lead to higher premiums or employer contribution costs passed to enrollees and businesses.
States will face administrative and budgetary pressure to implement Medicaid/CHIP changes starting in 2026, creating fiscal and operational burdens for state and local governments.
Limited supply of donor human milk-derived products could prevent covered infants from actually receiving the fortifier despite the coverage mandate.
Based on analysis of 2 sections of legislative text.
Requires Medicaid, CHIP, and private group and individual plans to cover donor human milk–derived human milk fortifier with no cost-sharing beginning Jan 1, 2026 (CHIP delay for some states).
Requires Medicaid, CHIP, and private group and individual health plans to cover donor human milk–derived human milk fortifier for infants under 1 year without any cost-sharing, beginning January 1, 2026. It adds this product as a mandatory Medicaid service, extends the no-cost rule to CHIP and to group health plans under federal insurance rules, and defines key terms and eligible prescribers. Also bars states from using benchmark-equivalent plans that exclude the no-cost fortifier benefit; allows a delayed CHIP start date for states that need to pass state law to comply.
Introduced July 21, 2025 by Morgan McGarvey · Last progress July 21, 2025