To amend titles XIX and XXI of the Social Security Act and title XXVII of the Public Health Service Act to require no-cost coverage of human milk fortifier.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill mandates that Medicaid, CHIP, and private health insurers provide coverage for human milk fortifier products used to supplement nutrition for premature and medically vulnerable infants, without imposing cost-sharing on families.
Who Benefits and How
Families with premature infants (born at 34 weeks or less) or underweight babies benefit by receiving medically necessary nutrition supplements at no out-of-pocket cost. Human milk fortifier manufacturers benefit from expanded market access through mandated coverage.
Who Bears the Burden and How
Health insurance companies and state Medicaid programs bear increased costs to cover human milk fortifiers. This may lead to small premium increases for all enrollees.
Key Provisions
- Mandates no-cost coverage starting January 1, 2026
- Covers infants born at 34 weeks gestation or less
- Covers infants with birth weight under 1800 grams
- Requires medical necessity determination by a qualified professional
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires Medicaid, CHIP, and private health insurance plans to cover human milk fortifier for premature and medically fragile infants at no cost to families.
Key Policy Areas
Healthcare, Children
Primary Purpose
Requires Medicaid, CHIP, and private health insurance plans to cover human milk fortifier for premature and medically fragile infants at no cost to families.
Policy Domains
Entire Bill
Identified Gains
Contextual inference, no direct clause citation- Families with premature infants
- Human milk fortifier manufacturers
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Health insurance companies
- State Medicaid programs
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. McGarvey (for himself, Ms. DeLauro, and Mr. Krishnamoorthi) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Families with premature infants, Families with premature infants on Medicaid
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
Key Definitions
Terms defined in this bill
A donor human milk-derived product furnished to infants under 1 year of age when medically necessary for premature, underweight, or medically fragile infants
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology