S. 5037: MediKids Act

This bill would expand Medicaid coverage for children and young adults in several major ways.

What changes it would make

• Extends Medicaid eligibility up to age 26. States would have to cover people from birth through age 25 under Medicaid, instead of ending coverage earlier for some age groups.
• Automatically enrolls newborns. For children born in a state on or after the bill’s effective date, the state would treat the child as having applied for Medicaid and would enroll the child at birth.
• Lets families opt out if the child already has other qualifying coverage. States would have to give parents, guardians, or custodial relatives a way to disenroll a child if the child already has other coverage that meets federal standards. Once a person turns 18, that notification and opt-out process would apply directly to the individual.
• Requires continuous eligibility through age 25. The bill would extend existing Medicaid continuous coverage rules so that children and young adults could keep coverage without frequent re-checks until age 26.
• Removes immigration-status restrictions for this age group. It would require states to provide Medicaid to eligible children and young adults under 26 regardless of whether they are lawfully present in the United States, under the bill’s specific rules.
• Makes the federal government pay the full cost for certain newly covered people. Starting two years after enactment, the federal share would be 100% for medical assistance provided to people covered under the new age-26 eligibility category who would not have qualified for full benefits under a state’s Medicaid rules or waiver as of January 1, 2025.
• Exempts these individuals from certain Medicaid work or community-engagement requirements. The bill updates existing exemptions so that people covered under the new age-26 category would not be subject to those requirements in the same way.
• Expands pediatric and young-adult Medicaid benefits. It would extend EPSDT, the Medicaid early and periodic screening, diagnostic, and treatment benefit, from age 21 to age 26, which generally means more comprehensive preventive and treatment services for that age group.
• Updates several related Medicaid and tax-code provisions. The bill makes technical and conforming changes so the new eligibility category works across different parts of federal law.

Timing

Most of the bill’s changes would take effect two years after enactment, though some conforming amendments would take effect immediately when the bill is enacted.

Relevant Companies

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