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

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I MEDICAID

Sec. 103. Permitting medicaid DSH allotments for territories

Section 1923(f) of the Social Security Act (42 U.S.C. 1396r–4(f)) is amended—

(1) in paragraph (6), by adding at the end the following new subparagraph:

Text this section adds to the law

(C) Territories

(i) Fiscal year 2026. For fiscal year 2026, the DSH allotment for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall bear the same ratio to $300,000,000 as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory (as estimated from time to time by the Secretary) bears to the sums of the number of such individuals residing in all of the territories.

(ii) Subsequent fiscal year. For each subsequent fiscal year, the DSH allotment for each such territory is subject to an increase in accordance with paragraph (3).

; and

(2) in paragraph (9), by inserting before the period at the end the following: , and includes, beginning with fiscal year 2026, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

II MEDICARE

A Part A

B Part B

C Medicare Advantage (Part C)

D Part D

III MISCELLANEOUS