H.R. 7118: Genomic Answers for Children’s Health Act of 2026

This bill, named the Genomic Answers for Children’s Health Act of 2026, aims to modify the Social Security Act to determine that whole genome sequencing and whole exome sequencing are covered under the Medicaid program for children with specific medical needs. Here are the key points of the bill:

Coverage of Genetic Testing

• The bill amends Section 1905 of the Social Security Act to include whole genome sequencing and whole exome sequencing as covered services under Medicaid when ordered by a physician for children suspected of having a genetic disorder, rare disease, or health condition of unclear origin.
• These conditions may include congenital anomalies, developmental delays, or intellectual disabilities.

Definition of Sequencing

• The bill provides definitions for whole genome sequencing and whole exome sequencing, emphasizing that it involves sequencing DNA to identify disease-causing genetic variants.
• This includes analysis and reports derived from such sequencing, and covers both the individual undergoing testing and their first-degree biological relatives.

Separate Payment Structure

• The legislation ensures that payment for these tests will be processed separately from other medical assistance services, rather than bundled.

Education and Outreach Initiatives

• The Secretary of Health and Human Services is tasked with raising awareness about these services among various stakeholders, including healthcare organizations and families of children with rare diseases.
• Outreach efforts will focus on ensuring understanding of the Medicaid benefits related to early and periodic screening, diagnostic, and treatment services.
• A report is required to be published within two years of enactment to provide information on payment amounts and the impact of these services on children's health outcomes.

Monitoring Implementation

• The bill directs the Comptroller General of the United States to evaluate the implementation of these amendments, including gathering feedback on access to sequencing services and identifying any ongoing barriers.
• It also considers challenges such as prior authorization processes and workforce issues affecting genetic counseling.

Effective Date

• The changes proposed in this bill would take effect on January 1, 2027.

Relevant Companies

• ILMN - Illumina, Inc.: A company that provides sequencing and genomic analysis technologies, which may see increased demand for its services due to expanded coverage under Medicaid.
• CGDX - Cgix, Inc.: They may benefit from the growth in genetic testing services as more patients gain access to whole genome and exome sequencing through Medicaid.
• GRMN - Garmin Ltd.: Though not directly in the genomics field, any health technology companies providing genomic solutions or partnerships might be indirectly impacted by increased genetic testing requirements.