Earned Benefits Equality and Family Reunification Act
- Bill Number
- H.R. 9054
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-29: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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
- 2026-06-24T15:54:27Z
AI-Generated Summary
Purpose The legislation establishes a 10-year demonstration program under Medicare (Title XVIII of the Social Security Act) to allow eligible beneficiaries to apply their benefits toward health coverage, premiums, and cost-sharing in selected foreign countries. The program aims to evaluate whether this approach improves care quality, lowers government costs, supports family reunification, and eases pressure on U.S. medical resources.
Key Provisions
- Program Structure: The Secretary of Health and Human Services must implement the program within one year of enactment, selecting at least 11 initial countries or subdivisions (including Canada, Germany, India, Israel, South Korea, the Philippines, Panama, Mexico, the Dominican Republic, and Ghana). The program caps participation at no fewer than 150,000 beneficiaries.
- Eligibility: Applies to individuals entitled to Medicare Part A and enrolled in Part B (with possible Medicare Advantage enrollment). Participants must reside in a selected country and agree to receive care there, though they retain full access to U.S.-based benefits. Participation is voluntary with a special election period option.
- Payments and Limits: Medicare covers items, services, premiums, and cost-sharing in selected countries, but payments cannot exceed the cost of equivalent U.S. services and exclude taxes funding foreign health systems. No duplicate payments are allowed for months when beneficiaries reside abroad.
- Administration and Oversight: The program may be run partly or fully through Medicare Advantage organizations. Participating physicians must hold good standing in their countries. Annual and final evaluations assess the program's goals, with recommendations for expansion. Fraud, waste, and abuse training and reporting systems are required.
- Flexibility: The Secretary may waive title provisions as needed, issue guidance on quality standards and targeting low-income participants, and use stakeholder input from the State Department, experts, beneficiaries, and foreign health system specialists.
Significant Changes to Existing Law This bill adds a new Section 1866H to Title XVIII, creating the first structured mechanism for Medicare to reimburse care delivered outside the United States on a broad scale. It introduces special election periods for program participation, allows administration through Medicare Advantage plans (treating payments as standard benefits), and provides funding from the Hospital Insurance and Supplementary Medical Insurance Trust Funds plus existing demonstration authority funds. Limitations on administrative and judicial review are established for program design elements, while preserving beneficiary appeal rights.
Potential Impacts
- Government Agencies: The Centers for Medicare & Medicaid Services would design, implement, and evaluate the program, with possible delegation to Medicare Advantage plans; the Department of State would be consulted during design.
- Citizens: Eligible Medicare beneficiaries, particularly those planning relocation or already living abroad, could access care in selected countries without losing benefits, potentially reducing out-of-pocket costs if foreign systems are lower-cost.
- International Relations: Formalizes partnerships with at least 11 nations' health systems, requiring coordination on quality standards and payment equivalence.
Main Stakeholders Affected
- Medicare beneficiaries (especially those with family ties abroad or seeking lower-cost care).
- Medicare Advantage organizations.
- Physicians and health providers in the selected countries.
- The Department of Health and Human Services and the Centers for Medicare & Medicaid Services.
- Foreign governments and their health insurance systems.
Notable Legal, Constitutional, or Political Implications The bill grants broad waiver authority and exempts certain program decisions from review under sections 1869 and 1878, while maintaining beneficiary appeal rights. It directs use of non-competitive contracting for administration and exempts activities from Paperwork Reduction Act requirements. The program explicitly targets low-income participants and emphasizes family reunification as an evaluation goal.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Espaillat, Adriano [D-NY-13]
Recent Actions
- 2026-05-29: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2026-05-29: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2026-05-29: Introduced in House
- 2026-05-29: Introduced in House
Bill Versions
- Earned Benefits Equality and Family Reunification Act — issued 2026-05-29 — PDF (10 pages)