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

II MEDICARE

A Part A

Sec. 201. Calculation of medicare DSH payments for IPPS hospitals in Puerto Rico

Section 1886(d)(9)(D)(iii) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as follows:

Text this section adds to the law

(iii) Subparagraph (F) (relating to disproportionate share payments), including application of subsection (r), except that for this purpose—

(I) the sum described in clause (ii) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(F)(ii)(I); and

(II) for discharges occurring on or after October 1, 2025, subclause (I) of paragraph (5)(F)(vi) shall be applied by substituting for the numerator described in such subclause the number of subsection (d) Puerto Rico hospital’s patient days for the cost reporting period involved which were made up of patients who (for such days) were entitled to benefits under part A of this title and were—

(aa) entitled to supplementary security income benefits (excluding any State supplementation) under title XVI;

(bb) eligible for medical assistance under a State plan under title XIX; or

(cc) receiving aid or assistance under any plan of the State approved under title I, X, XIV, or XVI.

B Part B

C Medicare Advantage (Part C)

D Part D

III MISCELLANEOUS