Sponsors (4)
Requires Medicaid/CHIP coverage and bans cost-sharing for donor human milk–derived human milk fortifier for qualifying infants starting Jan 1, 2026.
Official title: To amend titles XIX and XXI of the Social Security Act and title XXVII of the Public Health Service Act to require no-cost coverage of human milk fortifier.
Introduced July 21, 2025 by Morgan McGarvey · Last progress July 21, 2025
The bill greatly expands no-cost access to medically necessary human milk fortifier for eligible infants—reducing family out-of-pocket costs and standardizing clinical eligibility—while shifting costs onto state Medicaid programs and private insurers and creating implementation burdens that may affect budgets and timing of access.
Infants medically eligible (Medicaid, CHIP, and privately insured) will get medically necessary human milk fortifier covered with no cost-sharing starting Jan 1, 2026, expanding access across public and private plans.
Low- and middle-income families (Medicaid/CHIP enrollees and insured families) will face lower out-of-pocket costs for necessary infant nutrition, easing short-term family financial burden.
Clinicians and hospitals get clear medical-necessity criteria (gestational age ≤34 weeks, birth weight <1800 g, low current weight, or qualifying condition), standardizing eligibility and helping guide prescribing and coverage decisions.
State Medicaid programs will incur additional costs to cover the new benefit, putting pressure on state budgets and potentially requiring trade-offs or new funding decisions.
Private insurers and employer plans must cover fortifiers with no cost-sharing, which could increase premiums or employer health plan costs over time, affecting insured families and employers.
States may face administrative and implementation costs or delays (including passing enabling legislation and updating plans), which could postpone access for some families and create short-term complexity for state agencies.
Based on analysis of 2 sections of legislative text.
Makes donor human milk–derived human milk fortifier a mandatory Medicaid-covered medical benefit and bans cost-sharing for it under Medicaid and CHIP starting January 1, 2026 when a qualified clinician determines it is medically necessary for infants under 1 year for specific clinical reasons. Defines "human milk fortifier," lists qualifying clinical indications and authorized prescribers, and updates Medicaid statutory benefit and alternative benefit plan rules to require coverage without deduction or copayment.