Supporting Premature Infant Nutrition Act of 2025

Bill Number

H.R. 4569

Origin Chamber

House

Congress

119th Congress, Session 1

Status

Introduced

Latest Action

2025-07-21: Referred to the House Committee on Energy and Commerce.

Last Updated

2025-07-31T04:43:19Z

AI-Generated Summary

Purpose of the Legislation

The "Supporting Premature Infant Nutrition Act of 2025" (H.R. 4569) aims to ensure that certain nutritional products made from donor human milk—known as human milk fortifiers—are covered at no cost under public health programs and private insurance. This is intended to support the health of vulnerable infants, particularly those born prematurely or with low birth weight, by making medically necessary nutrition more accessible without financial barriers.

Key Provisions

• Mandatory Coverage in Medicaid: Starting January 1, 2026, Medicaid must cover human milk fortifier as a required benefit for eligible infants under 1 year of age. This applies to standard Medicaid plans, medically needy programs (for low-income individuals who don't qualify for full Medicaid), and alternative benefit plans. No deductibles, copays, or other charges (cost-sharing) are allowed.
• Definition of Human Milk Fortifier: The product is defined as a specialty nutritional item derived from screened donor human milk that has been concentrated or had components removed. It must be deemed medically necessary by a qualified professional (e.g., doctor, nurse practitioner, physician's assistant, registered dietitian, or other state-licensed expert) for infants who:
• Were born at 34 weeks gestation or earlier.
• Had a birth weight under 1,800 grams (about 4 pounds).
• Have low body weight below healthy levels.
• Have a congenital (present at birth) or acquired condition that the product can improve or aid recovery from.
• Coverage in Children's Health Insurance Program (CHIP): CHIP must also provide no-cost coverage for human milk fortifier starting January 1, 2026, with an exception for states needing new legislation (they get extra time until after their next legislative session).
• Coverage in Private Insurance: Group health plans and individual health insurance policies must cover human milk fortifier without cost-sharing, effective for plan years beginning on or after January 1, 2026.
• Enforcement and Implementation: States cannot offer benchmark or equivalent coverage plans under Medicaid or CHIP without including this benefit. The U.S. Department of Health and Human Services (HHS) oversees compliance.

Significant Changes to Existing Law

• Amendments to Social Security Act (Titles XIX and XXI): Adds human milk fortifier as a new mandatory service under Medicaid (Section 1905(a)) and CHIP (Section 2103), expanding the list of covered benefits. It prohibits cost-sharing for this item, similar to protections for other essential pediatric services like vaccines or well-child visits.
• Amendments to Public Health Service Act (Title XXVII): Introduces a new section (2730) requiring no-cost coverage in private group and individual health plans, aligning public and private insurance requirements for this benefit.
• These changes build on existing laws by explicitly mandating coverage for a specific infant nutrition product, which was not previously required, and integrating it into cost-sharing exemptions.

Potential Impacts

• On Government Agencies: HHS and the Centers for Medicare & Medicaid Services (CMS) will need to update regulations, monitor state compliance, and potentially increase federal funding to states for the added Medicaid/CHIP costs. States may face administrative burdens to implement coverage and train providers.
• On Citizens: Families with premature or low-birth-weight infants will gain easier access to this nutrition without out-of-pocket expenses, potentially improving infant health outcomes like growth and reduced complications. Low-income families relying on Medicaid/CHIP will benefit most directly.
• On International Relations: No direct impacts, as the bill focuses on domestic U.S. health programs and insurance.
• Broader Effects: Could lower long-term healthcare costs by preventing nutrition-related issues in infants, but may raise short-term premiums or program expenses for insurers and taxpayers.

Main Stakeholders Affected

• Infants and Families: Primarily premature infants under 1 year and their parents/caregivers, especially in low-income households.
• Healthcare Providers: Doctors, nurses, dietitians, and other professionals who assess medical necessity and prescribe the product.
• Government Entities: Federal agencies (HHS, CMS), state Medicaid/CHIP administrators, and legislatures (for implementation delays if needed).
• Health Insurers and Plans: Private companies offering group or individual coverage, which must absorb costs without passing them to consumers via charges.
• Milk Banks and Producers: Organizations that process and donate human milk, potentially seeing increased demand and reimbursements.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Strengthens enforcement through HHS oversight, with potential penalties for non-compliant states or insurers. The bill's definitions clarify medical necessity to avoid disputes over coverage eligibility.
• Constitutional Implications: Relies on Congress's authority under the Spending Clause (to attach conditions to federal funds for Medicaid/CHIP) and Commerce Clause (to regulate health insurance markets). It avoids federalism issues by allowing states time for legislative adjustments.
• Political Implications: Promotes public health equity for vulnerable newborns, potentially garnering bipartisan support due to its focus on child welfare. However, it could spark debates over expanding mandatory benefits amid concerns about federal overreach or rising healthcare costs.

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

Sponsor

Rep. McGarvey, Morgan [D-KY-3]

Cosponsors (2)

Rep. DeLauro, Rosa L. [D-CT-3], Rep. Krishnamoorthi, Raja [D-IL-8]

Recent Actions

• 2025-07-21: Referred to the House Committee on Energy and Commerce.
• 2025-07-21: Introduced in House
• 2025-07-21: Introduced in House

Bill Versions

• Supporting Premature Infant Nutrition Act of 2025 — issued 2025-07-21 — PDF (9 pages)