Bridge to Medicaid Act of 2025
Sponsored By: Representative Sewell
Introduced
Summary
Expand affordability and access to ACA coverage for low-income people. The Bridge to Medicaid Act of 2025 would temporarily make premiums and out-of-pocket costs cheaper, extend enrollment windows for lower-income households, and boost federal Medicaid matching for newly eligible people.
Show full summary
- Families and low-income households would see broader premium tax credit eligibility and expanded cost-sharing reductions for plan years 2026–2028, including rules that affect people with incomes up to 400 percent of the federal poverty line.
- People at or below 138 percent of the poverty line would be treated specially so plans cover 99 percent of allowed costs for them and issuers would receive payments equal to 12 percent of those costs in 2026–2028; silver plans would add benefits like non-emergency medical transportation in 2026–2027 with no cost sharing.
- Residents in states that have not expanded Medicaid and newly eligible mandatory individuals would get higher federal matching rates: 93 percent in 2026–2028 and 90 percent from 2029 onward.
- Low-income workers offered employer coverage, including certain small‑employer reimbursements, could remain eligible for premium tax credits if household income is 138 percent of poverty or less.
- The bill would fund outreach and enrollment supports with $105 million for a federal education program in FY2026, navigator grants starting at $10 million in FY2026 and $20 million in FY2027–2028, and a $65 million appropriation for FY2026.
*Would increase federal spending through new appropriations, dedicated outreach funds, and higher Medicaid matching rates.*
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
Low-income marketplace plans with near-zero costs
If enacted, people with income at or below 138% of the poverty line could use a continuous sign-up window in 2026–2028 if not eligible for other minimum coverage. In those years, their plan would have to cover 99% of allowed costs. In 2026–2027, silver plans would add extra benefits, like non-emergency medical rides, with no cost sharing. For 2025 only, anyone found at or below 138% of poverty would be treated as at 100% for cost-sharing help all year. The government would pay insurers 12% of allowed costs for this group in 2026–2028 and provide $65 million in FY2026 to run these changes.
Bigger marketplace tax credits, 2026–2028
For tax years 2026–2028, you could get marketplace premium tax credits even if your income is below 100% of poverty. If your income is at or below 138% of poverty, you could claim the credit even if your job offers coverage or you have a small-employer HRA; that HRA would not count as affordable. If your income is under 200% of poverty, any payback after reconciliation would be capped at $300 ($150 for some single filers). A non-filer exception would apply when an Exchange projected your income at or below 138% of poverty and paid advance credits. Exchanges would share the information needed to make these decisions.
Higher federal share for Medicaid expansion
The federal share of Medicaid costs for newly eligible adults would be 93% in 2026–2028. Starting in 2029, it would be 90% each year. This could help states keep coverage for that group with less state spending.
Cost-sharing help up to 400% poverty
For plan years 2026–2028, people with income up to 400% of the poverty line could get cost-sharing reductions. This could lower deductibles and copays when enrolled in qualified marketplace plans.
More navigator help and outreach funds
The government would fund more navigator help and outreach in states that have not expanded Medicaid for low‑income adults. For federally run marketplaces, at least $10 million in FY2026 and $20 million in FY2027–FY2028 would come from insurer user fees. An extra $105 million ($15 million in FY2026; $30 million in FY2027 and FY2028) would fund culturally appropriate outreach about qualified marketplace plans only.
Sponsors & CoSponsors
Sponsor
Sewell
AL • D
Cosponsors
Figures
AL • D
Sponsored 5/7/2025
Roll Call Votes
No roll call votes available for this bill.
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