HR7868-119

What This Bill Does

The Expanding Support for Living Donors Act changes the federal Living Organ Donation Reimbursement Program so grant recipients may not deny reimbursement based on income when a donor's household income is at or below 700 percent of the federal poverty line. Reimbursement would cover qualifying expenses up to the donor's actual costs or $10,000 in fiscal year 2027, whichever is less. The cap would rise annually with the Consumer Price Index.

The Secretary of Health and Human Services may temporarily lower the cap for a grantee that lacks enough funds to reimburse all donors, but must notify Congress 30 days beforehand and explain the decision. A reduction cannot cut an already approved donor's reimbursement or lower the inflation baseline for later years. The bill authorizes whatever sums are necessary for fiscal years 2028 through 2037.

Beginning in fiscal year 2027, HHS must issue a public annual report on unmet reimbursement needs, application volume, payment amounts, donor demographics, expense categories, organ types, administrative costs, completed donations, Medicare savings, outreach, financial barriers, and the funding needed for full reimbursement. GAO must separately study within one year whether Medicare could use existing authority to pay costs now covered by the reimbursement program and recommend any needed changes.

Who Benefits and How

Living organ donors with household income up to 700 percent of poverty benefit from protected eligibility and an inflation-adjusted reimbursement cap of $10,000 in 2027. Donors already approved for reimbursement are protected from later emergency cap reductions. Transplant recipients may benefit indirectly if reduced donor expenses make living donation more feasible. Program grantees gain renewed federal funding authority through 2037.

Who Bears the Burden and How

Living-donor reimbursement grantees must apply the expanded eligibility and cap rules and provide detailed program data. HHS administrators must monitor funding sufficiency, notify Congress before lowering caps, publish extensive annual reports, and administer renewed appropriations. Federal health appropriations bear the reimbursement cost. GAO health-policy staff must complete the Medicare authority study, and Medicare administrators may need to provide program and cost information.

Key Provisions

• Bars income-based denial for donors at or below 700 percent of the federal poverty line.
• Sets the fiscal year 2027 reimbursement cap at $10,000 and indexes it to inflation thereafter.
• Allows temporary grantee-specific cap reductions only after a funding finding and 30 days' notice to Congress.
• Protects already approved reimbursements from a later cap reduction.
• Authorizes necessary funding for fiscal years 2028 through 2037.
• Requires annual public reporting on applications, payments, demographics, expenses, organ types, outcomes, Medicare savings, and unmet need.
• Requires GAO to study whether Medicare can pay covered donor costs under existing authority.
• Requires GAO recommendations on statutory changes needed to shift eligible costs to Medicare.