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
(a) In general. Section 1108 of the Social Security Act (42 U.S.C. 1308) is amended—
(1) in subsection (f), in the matter preceding paragraph (1), by striking subsections (g) and (h) and inserting subsections (g), (h), and (j);
(2) in subsection (g)(2), in the matter preceding subparagraph (A), by inserting subsection (j) and after subject to;
(3) in subsection (i), by striking paragraph (4); and
(4) by adding at the end the following new subsection:
(j) Sunset of medicaid funding limitations for puerto rico, the virgin islands, guam, the northern mariana islands, and american samoa. Subsections (f) and (g) shall not apply to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa beginning with fiscal year 2026.
(b) Conforming amendments
(1) Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended by striking , the limitation in section 1108(f),,.
(2) Section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u)) is amended by striking paragraph (4).
(c) Effective date. The amendments made by this section shall apply beginning with fiscal year 2026.
II MEDICARE
A Part A
B Part B
C Medicare Advantage (Part C)
D Part D
III MISCELLANEOUS