H.R. 6494

Territories Health Equity Act of 2025

Sponsor: Stacey E. Plaskett

4 cosponsors
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Official summary

Written by the Congressional Research Service.

Territories Health Equity Act of 2025

This bill alters provisions relating to the treatment of U.S. territories under Medicaid, Medicare, and Medicare Advantage.

For example, the bill

  • eliminates Medicaid funding limitations for U.S. territories beginning in FY2026,
  • exempts an individual from late-enrollment penalties for Medicare medical services if the individual resided in Puerto Rico as of the date of eligibility and the individual enrolls within five years of such date, and
  • establishes minimum criteria for certain elements used in Medicare Advantage payment calculations for areas within U.S. territories.

The bill also allows residents of U.S. territories who are unable to obtain health insurance through their employer or a health insurance exchange to instead obtain coverage that is at least as broad as the coverage available to Members of Congress and their staff through the District of Columbia exchange.

Text of the bill

Expand all
Sec. 1. Short title; table of contents

(a) Short title. This Act may be cited as the Territories Health Equity Act of 2025.

(b) Table of contents. The table of contents for this Act is as follows: Sec. 1. Short title; table of contents.Title I—MEDICAIDSec. 101. Elimination of general Medicaid funding limitations (CAP) for territories.Sec. 102. Elimination of specific Federal medical assistance percentage (FMAP) limitation for Puerto Rico.Sec. 103. Permitting Medicaid DSH allotments for territories.Title II—MEDICARESubtitle A—Part ASec. 201. Calculation of Medicare DSH payments for IPPS hospitals in Puerto Rico.Sec. 202. Rebasing target amount for hospitals in territories.Sec. 203. Medicare DSH target adjustment for hospitals in territories.Subtitle B—Part BSec. 211. Eliminating late enrollment penalties under Part B of the Medicare program for certain individuals residing in Puerto Rico.Subtitle C—Medicare Advantage (Part C)Sec. 221. Adjustment in benchmark for low-base payment counties in Puerto Rico.Subtitle D—Part DSec. 231. Automatic eligibility of certain low-income territorial residents for premium and cost-sharing subsidies under the Medicare program; sunset of enhanced allotment program.Title III—MISCELLANEOUSSec. 301. Medicaid and CHIP territory transparency and information.Sec. 302. Report on exclusion of territories from exchanges.Sec. 303. Access to coverage for individuals in certain areas without any available exchange plans.

I MEDICAID

II MEDICARE

A Part A

B Part B

C Medicare Advantage (Part C)

D Part D

III MISCELLANEOUS