HR 4543

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IN THE HOUSE OF REPRESENTATIVES

July 17, 2025

Ms. Waters (for herself, Ms. Garcia of Texas, Ms. Norton, Ms. Velazquez, Ms. Wasserman Schultz, Mrs. Dingell, Ms. Clarke of New York, Mr. Fields, Mr. Johnson of Georgia, Ms. Tlaib, Mr. Thompson of Mississippi, Ms. Sewell, Mr. Gottheimer, Mrs. Watson Coleman, Mr. Thanedar, Ms. Lee of Pennsylvania, Mr. Latimer, Ms. Wilson of Florida, Mr. Veasey, Mr. Cohen, Mr. Lynch, Mrs. McIver, Mr. Garcia of Illinois, Mrs. Cherfilus-McCormick, Ms. Moore of Wisconsin, and Mr. Costa) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

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

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 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 (42 U.S.C. 1396a) is amended—

(1) in subsection (a)(10)—

(A) in subparagraph (A)—

(i) in the matter preceding clause (i), by striking “and (30)” and inserting “(30), and

(32)”;

(ii) in clause (i)—

(I) in subclause (VIII), by striking “or” at the end;

(II) in subclause (IX), by adding “or” at the end; and

(III) by adding at the end the following new subclause:

“(X) who are described in subsection (aa) (relating to certain breast or cervical cancer patients);”; and

(iii) in clause (ii), by striking subclause

(XVIII); and

(B) in the matter at the end, in subdivision (XIV), by striking “subparagraph (A)(10)(ii)(XVIII)” and inserting “subparagraph (A)(10)(i)(X)”; and

(2) in subsection (aa)—

(A) by striking paragraphs (1) and (2);

(B) by redesignating paragraphs (3) and (4) as paragraphs (1) and (2), respectively; and

(C) in paragraph (2), as so redesignated, by inserting “as in effect on the day before the date of the enactment of the Patient Protection and Affordable Care Act,” after “(42 U.S.C. 300gg(c)),”.

(b) Inclusion of Breast Reconstruction as Medical Assistance.— Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—

(1) in paragraph (31), by striking “and” at the end;

(2) by redesignating paragraph (32) as paragraph (33); and

(3) by inserting after paragraph (31) the following new paragraph:

“(32) breast reconstruction following a medically necessary mastectomy; and”.

(c) Conforming Amendments.—

(1) FMAP.—Section 1905(b)(4) of the Social Security Act (42 U.S.C. 1396d(b)(4)) is amended by striking “section 1902(a)(10)(A)(ii)(XVIII)” and inserting “section 1902(a)(10)(A)(i)(X)”.

(2) Cost sharing.—

(A) In general.—Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—

(i) in subparagraph (I), by striking “or” at the end;

(ii) in subparagraph (J), by striking “; and” at the end and inserting “, or”; and

(iii) by adding at the end the following new subparagraph:

“(K) 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 (42 U.S.C. 1396o-1(b)(3)) is amended—

(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. <all>