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
III MISCELLANEOUS
(a) Publication of information on federal expenditures under medicaid and CHIP in the territories. Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall publish, and periodically update, on the internet site of the Centers for Medicare & Medicaid Services information on Medicaid and CHIP carried out in the territories of the United States. Such information shall include, with respect to each such territory—
(1) the income levels established by the territory for purposes of eligibility of an individual to receive medical assistance under Medicaid or child health assistance under CHIP;
(2) the number of individuals enrolled in Medicaid and CHIP in such territory;
(3) any State plan amendments in effect to carry out Medicaid or CHIP in such territory;
(4) any waiver of the requirements of title XIX or title XXI issued by the Secretary to carry out Medicaid or CHIP in the territory, including a waiver under section 1115 of the Social Security Act (42 U.S.C. 1315), any application for such a waiver, and any documentation related to such application (including correspondence);
(5) the amount of the Federal and non-Federal share of expenditures under Medicaid and CHIP in such territory;
(6) the systems in place for the furnishing of health care items and services under Medicaid and CHIP in such territory;
(7) the design of CHIP in such territory; and
(8) other information regarding the carrying out of Medicaid and CHIP in the territory that is published on such internet site with respect to carrying out Medicaid and CHIP in each State and the District of Columbia.
(b) Definitions. In this section:
(1) CHIP. The term CHIP means the State Children’s Health Insurance Program under title XXI of the Social Security Act.
(2) Medicaid. The term Medicaid means the Medicaid program under title XIX of the Social Security Act.
(3) Territory. The term territory of the United States includes Puerto Rico, the Virgin Islands of the United States, Guam, the Northern Mariana Islands, and American Samoa.