H.R. 6494
Territories Health Equity Act of 2025
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
I MEDICAID
II MEDICARE
A Part A
B Part B
C Medicare Advantage (Part C)
D Part D
(a) Automatic eligibility of certain low-Income territorial residents for premium and cost-Sharing subsidies under the medicare program
(1) In general. Section 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)) is amended—
(A) in subparagraph (B)(v)—
(i) in subclause (I), by striking and at the end;
(ii) in subclause (II), by striking the period and inserting ; and; and
(iii) by inserting after subclause (II) the following new subclause:
(III) with respect to plan years beginning on or after January 1, 2026, shall provide that any part D eligible individual who is enrolled for medical assistance under the State Medicaid plan of a territory (as defined in section 1935(f)) under title XIX (or a waiver of such a plan) shall be treated as a subsidy eligible individual described in paragraph (1).
; and
(B) in subparagraph (F), by adding at the end the following new sentence: The previous sentence shall not apply with respect to eligibility determinations for premium and cost-sharing subsidies under this section made on or after January 1, 2026..
(2) Conforming amendment. Section 1860D–31(j)(2)(D) of the Social Security Act (42 U.S.C. 1395w–141(j)(2)(D)) is amended by adding at the end the following new sentence: The previous sentence shall not apply with respect to amounts made available to a State under this paragraph on or after January 1, 2026..
(b) Sunset of enhanced allotment program
(1) In general. Section 1935(e) of the Social Security Act (42 U.S.C. 1396u–5(e)) is amended—
(A) in paragraph (1)(A), by inserting after such State the following: before January 1, 2026; and
(B) in paragraph (3)—
(i) in subparagraph (A), in the matter preceding clause (i), by inserting after a year the following: (before 2026); and
(ii) in subparagraph (B)(iii), by striking a subsequent year and inserting each of fiscal years 2010 through 2025.
(2) Territory defined. Section 1935 of the Social Security Act (42 U.S.C. 1396u–5) is amended by adding at the end the following new subsection:
(f) Territory defined. In this section, the term territory means Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.
III MISCELLANEOUS