No-Cost Breast Examinations in Medicaid Act of 2026
- Bill Number
- H.R. 8729
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-11: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-05-21T20:07:42Z
AI-Generated Summary
Purpose
The No-Cost Breast Examinations in Medicaid Act of 2026 (H.R. 8729) aims to ensure that certain breast cancer-related exams are provided without cost sharing (no copays, deductibles, or other out-of-pocket fees) under Medicaid, the joint federal-state health program for low-income individuals. It also makes screening mammography a required benefit.
Key Provisions
- No Cost Sharing for Specific Exams:
- Exempts diagnostic breast examinations (follow-up tests like diagnostic mammography, MRI, or ultrasound for abnormalities detected in screening or other checks) from cost sharing.
- Exempts supplemental breast examinations (additional screening tests like MRI or ultrasound for high-risk individuals with no detected abnormality, based on family history or risk factors).
- Definitions follow National Comprehensive Cancer Network (NCCN) Guidelines for medical necessity.
- Applies to standard Medicaid and alternative cost-sharing plans.
- Mandatory Screening Mammography:
- Requires states to cover screening mammography rated A or B by the U.S. Preventive Services Task Force (USPSTF) as a core Medicaid benefit.
- Effective Date: Changes apply to services provided 1 year after enactment.
Significant Changes to Existing Law
- Amends Title XIX of the Social Security Act (Medicaid provisions):
- Adds breast exams to lists of services exempt from cost sharing (sections 1916 and 1916A).
- Defines the new exam terms in section 1905.
- Elevates screening mammography to a mandatory benefit (sections 1902 and 1905), previously optional for states.
- Shifts these services from potential state discretion or cost-sharing to federally required, no-cost coverage.
Potential Impacts
- On Citizens: Improves access to breast cancer detection for Medicaid enrollees (about 80 million low-income Americans), especially women with risk factors, by removing financial barriers and encouraging early diagnosis.
- On Government Agencies: States must update Medicaid plans, potentially increasing costs (borne by federal and state governments); Centers for Medicare & Medicaid Services (CMS) will oversee compliance.
- No notable international relations impact.
Main Stakeholders Affected
- Medicaid Beneficiaries: Primarily women, including those with high breast cancer risk.
- State Medicaid Agencies: Must implement changes and cover costs.
- Healthcare Providers: Radiologists and imaging centers benefit from increased utilization.
- Advocacy Groups: Breast cancer organizations (e.g., those aligned with NCCN or USPSTF guidelines).
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens federal mandates on states via Medicaid funding conditions, enforceable through CMS approvals; relies on established guidelines (NCCN, USPSTF) to define "medically necessary."
- Constitutional: Operates under Congress's spending power (Article I, Section 8), consistent with prior Medicaid expansions.
- Political: Promotes preventive women's health without partisan controversy in text; referred to House Committee on Energy and Commerce for review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2026-05-11: Referred to the House Committee on Energy and Commerce.
- 2026-05-11: Introduced in House
- 2026-05-11: Introduced in House
Bill Versions
- No-Cost Breast Examinations in Medicaid Act of 2026 — issued 2026-05-11 — PDF (5 pages)