Medicaid Breast Cancer Access to Treatment Act

Bill Number

H.R. 4543

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-07-17: Referred to the House Committee on Energy and Commerce.

Last Updated

2025-09-10T08:06:41Z

AI-Generated Summary

Summary of H.R. 4543: Medicaid Breast Cancer Access to Treatment Act

Purpose of the Legislation

This bill amends the Social Security Act to mandate Medicaid coverage for certain individuals with breast or cervical cancer, ensuring access to treatment services including breast reconstruction following mastectomy.

Key Provisions Outlined

• Mandatory Eligibility: Adds individuals described in the new subsection (aa) of section 1902 as a required eligibility group under Medicaid.
• Breast Reconstruction Coverage: Explicitly includes breast reconstruction after a medically necessary mastectomy as a covered medical assistance service.
• Cost-Sharing Protections: Prohibits cost-sharing for services provided to the newly covered group.
• Redesignation and Updates: Removes prior optional eligibility language and updates references in related sections for consistency.
• Effective Date: Changes apply starting one year after the bill's enactment.

Significant Changes to Existing Law Introduced

• Converts the breast and cervical cancer eligibility category from optional to mandatory by shifting it from section 1902(a)(10)(A)(ii)(XVIII) to section 1902(a)(10)(A)(i)(X).
• Adds breast reconstruction explicitly to the list of covered services under section 1905(a).
• Updates the Federal Medical Assistance Percentage (FMAP) and cost-sharing rules to align with the new mandatory status.
• Removes outdated paragraphs from subsection (aa) and incorporates prior statutory references.

Potential Impacts

• On Government Agencies: Requires state Medicaid programs to expand coverage, potentially increasing federal and state expenditures for medical services and administrative compliance.
• On Citizens: Provides guaranteed access to treatment and reconstruction services for eligible individuals with breast or cervical cancer, reducing financial barriers.
• On International Relations: No direct impacts identified in the legislation.

Main Stakeholders Affected

• Individuals diagnosed with breast or cervical cancer who meet eligibility criteria.
• State Medicaid agencies responsible for implementing the coverage expansions.
• Healthcare providers delivering cancer treatment and reconstruction services.
• Federal agencies, including the Centers for Medicare & Medicaid Services, overseeing compliance and funding.

Notable Legal, Constitutional, or Political Implications

• The bill reinforces Medicaid's role in providing essential health services without altering core constitutional structures.
• It may raise questions regarding state flexibility in program design due to the shift from optional to mandatory eligibility.
• No specific political or international legal implications are addressed in the text.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Waters, Maxine [D-CA-43]

Cosponsors (29)

Rep. Garcia, Sylvia R. [D-TX-29], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Velázquez, Nydia M. [D-NY-7], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Dingell, Debbie [D-MI-6], Rep. Clarke, Yvette D. [D-NY-9], Rep. Fields, Cleo [D-LA-6], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Tlaib, Rashida [D-MI-12], Rep. Thompson, Bennie G. [D-MS-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Gottheimer, Josh [D-NJ-5], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Thanedar, Shri [D-MI-13], Rep. Lee, Summer L. [D-PA-12], Rep. Latimer, George [D-NY-16], Rep. Wilson, Frederica S. [D-FL-24], Rep. Veasey, Marc A. [D-TX-33], Rep. Cohen, Steve [D-TN-9], Rep. Lynch, Stephen F. [D-MA-8], Rep. McIver, LaMonica [D-NJ-10], Rep. García, Jesús G. "Chuy" [D-IL-4], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Moore, Gwen [D-WI-4], Rep. Costa, Jim [D-CA-21], Rescom. Hernández, Pablo Jose [D-PR-At Large], Rep. Trahan, Lori [D-MA-3], Rep. McDonald Rivet, Kristen [D-MI-8], Rep. McBride, Sarah [D-DE-At Large]

Recent Actions

• 2025-07-17: Referred to the House Committee on Energy and Commerce.
• 2025-07-17: Introduced in House
• 2025-07-17: Introduced in House

Bill Versions

• Medicaid Breast Cancer Access to Treatment Act — issued 2025-07-17 — PDF (5 pages)