Bridge to Medicaid Act of 2025
- Bill Number
- H.R. 3257
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-02-06T18:51:37Z
AI-Generated Summary
Purpose of the Legislation
The Bridge to Medicaid Act of 2025 aims to provide temporary affordable health insurance options for low-income individuals in states that have not expanded Medicaid under the Affordable Care Act (ACA). It targets people with household incomes up to 138% of the federal poverty line (FPL), bridging the "coverage gap" where these individuals earn too much for traditional Medicaid but too little for subsidized marketplace plans. The act introduces enhancements to ACA marketplaces, premium tax credits, and Medicaid funding for a limited period (primarily 2026–2028) to make coverage more accessible without requiring states to expand Medicaid.
Key Provisions
- Cost-Sharing Reductions for Qualified Health Plans (Section 2(a)):
- Temporarily extends premium subsidies and reduces out-of-pocket costs (like deductibles and copays) for individuals up to 400% of the FPL in plan years 2026–2028.
- For those at or below 138% FPL, treats income as 100% FPL to maximize reductions, ensuring plans cover 99% of allowed medical costs.
- Provides federal payments to insurers to reimburse these reductions, funded by new appropriations from the U.S. Treasury.
- Expanded Enrollment Opportunities (Section 2(b)):
- Creates special continuous enrollment periods starting January 1, 2026, through December 31, 2028, for low-income individuals (up to 138% FPL) who lack other affordable coverage options.
- Allows year-round sign-up for ACA marketplace plans during this window, bypassing standard open enrollment limits.
- Additional Benefits for Low-Income Enrollees (Section 2(c)):
- For silver-level plans in 2026–2027, requires coverage of extra benefits for those up to 138% FPL, including non-emergency medical transportation (e.g., rides to doctor visits) and certain home- or community-based services (like personal care aides) that mimic Medicaid perks.
- These benefits are provided without copays or provider restrictions, with federal reimbursements to insurers via Treasury appropriations.
- Education and Outreach Efforts (Section 2(d)):
- Mandates culturally and linguistically appropriate outreach by the Department of Health and Human Services (HHS) in non-expansion states to inform eligible low-income residents about marketplace plans and subsidies.
- Allocates $105 million for fiscal years 2026–2028, plus boosts funding for navigator programs (assisters who help with enrollment) using user fees from insurers, totaling at least $10–20 million annually.
- Temporary Expansion of Premium Tax Credits (Section 3):
- Removes income floors for premium tax credits (normally starting at 100% FPL) for tax years 2026–2028, making credits available to more low-income people.
- Allows credits even if affordable employer coverage is offered, for those up to 138% FPL; exempts certain small employer health plans from counting as "affordable."
- Limits repayment of excess advance credits to $300 (or $150 for single filers under certain tax rules) for those under 200% FPL, and waives filing requirements for very low-income non-filers projected at 138% FPL or below.
- Exempts low-income employees (up to 138% FPL) from employer penalties under the ACA's shared responsibility rules if they receive subsidies.
- Increased Federal Funding for Medicaid Expansion (Section 4):
- Raises the Federal Medical Assistance Percentage (FMAP, the federal share of state Medicaid costs) to 93% for newly eligible individuals in 2026–2028 (up from current levels), then 90% starting 2029 onward.
- Overall Funding (Section 2(e)):
- Appropriates $65 million to HHS for fiscal year 2026 to implement these changes.
Significant Changes to Existing Law
- ACA Amendments: Expands cost-sharing reductions beyond current limits (up to 250% FPL) and adds temporary rules for higher incomes and deeper subsidies for the lowest earners. Introduces new benefits not previously required in marketplace plans and enables continuous enrollment, which deviates from the ACA's standard annual open enrollment.
- Tax Code Changes (Internal Revenue Code Section 36B): Eliminates income eligibility barriers for premium credits and adjusts employer-related rules, making subsidies more forgiving for low-income workers—reversing some ACA restrictions on overlapping employer and marketplace coverage.
- Medicaid FMAP Adjustments (Social Security Act Section 1905): Temporarily increases the federal match rate for expansion populations from 90% to 93% through 2028, providing a short-term incentive for states but reverting afterward.
These changes are temporary, sunsetting after 2028, and apply only to non-expansion states for outreach.
Potential Impacts
- On Citizens: Low-income individuals (especially in the 12 non-expansion states, affecting about 2 million in the coverage gap) gain easier access to low- or no-cost health plans, potentially reducing uninsured rates and improving health outcomes by covering transportation and community services. However, benefits expire after 2028, which could lead to coverage disruptions.
- On Government Agencies: HHS and the IRS face increased administrative burdens for subsidies, outreach, and reimbursements, with new appropriations totaling over $170 million plus ongoing FMAP boosts (estimated federal cost: billions annually). States in non-expansion categories may see indirect pressure to expand Medicaid to sustain coverage.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. residents.
Main Stakeholders Affected
- Low-Income Individuals: Primary beneficiaries, particularly adults up to 138% FPL (~$20,000 for an individual or $41,000 for a family of four in 2025) without other coverage.
- Health Insurance Issuers: Receive federal reimbursements for reduced costs but must offer enhanced plans and benefits in marketplaces.
- States: Non-expansion states gain outreach support but no direct Medicaid expansion mandate; all states benefit from higher FMAP for any expansion populations.
- Federal Government: HHS (implementation and payments), IRS (tax credit administration), and Treasury (funding appropriations).
- Healthcare Providers and Navigators: Increased enrollment could boost patient volumes; navigators get more funding to assist underserved groups like minorities, rural residents, and veterans.
Notable Legal, Constitutional, or Political Implications
- Legal: Builds on the ACA without altering its core structure, using amendments to avoid new programs. Temporary nature limits long-term commitments, but appropriations from general Treasury funds could face budget reconciliation challenges. Ensures compliance with ACA anti-discrimination rules through tailored outreach.
- Constitutional: No major issues, as it involves federal spending on interstate commerce (health insurance) and general welfare, consistent with Supreme Court rulings upholding the ACA.
- Political: Acts as a bipartisan "bridge" to encourage Medicaid expansion in holdout states by offering short-term relief, potentially reducing political divides on healthcare. Could spark debates on federal overreach into state programs and fiscal sustainability, with costs adding to national debt amid expiring ACA enhancements.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Sewell, Terri A. [D-AL-7]
Cosponsors (1)
Rep. Figures, Shomari [D-AL-2]
Recent Actions
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-07: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-05-07: Introduced in House
- 2025-05-07: Introduced in House
Bill Versions
- Bridge to Medicaid Act of 2025 — issued 2025-05-07 — PDF (19 pages)