Genomic Answers for Children’s Health Act of 2026
Sponsored By: Representative Peters
Introduced
Summary
Medicaid coverage for whole genome and whole exome sequencing would be established as a first‑tier diagnostic test for children suspected of genetic disorders, rare diseases, or unexplained conditions. The bill would require separate payment for sequencing and direct federal reviews and reports to support state implementation.
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- Families and children: Children with suspected genetic disorders, rare diseases, one or more congenital anomalies, global developmental delay, or intellectual disability would be eligible for whole genome sequencing and whole exome sequencing in inpatient and outpatient settings when ordered by a physician or other provider acting within their scope of practice.
- Payment and providers: Medicaid payment for whole genome sequencing and whole exome sequencing would be made separately and not bundled with other medical assistance, creating a distinct reimbursement path for labs and clinicians.
- Implementation and oversight: The Secretary of Health and Human Services would convene national organizations and stakeholders and publish a report within two years on State payment amounts, numbers of children sequenced, health outcomes, and services provided. The Comptroller General would collect implementation feedback, assess access issues including prior authorization and workforce or reimbursement challenges for genetic counselors, and make recommendations. The changes would apply beginning January 1, 2027.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Medicaid coverage for genome tests
If enacted, this bill would require Medicaid to cover whole genome and whole exome sequencing for children suspected of genetic disorders, rare diseases, or unexplained medical conditions. The test would be covered in inpatient or outpatient settings when ordered by a physician or other provider within their state scope of practice. Sequencing would include analysis, interpretation, and reports and can include a first-degree relative if needed for diagnosis. Payment for these tests would be made separately and not bundled with other Medicaid payments. This coverage and payment rule would take effect January 1, 2027.
GAO study on sequencing access
If enacted, the Comptroller General would collect and analyze feedback on implementation of the Medicaid sequencing rules and assess impacts on access. The study would look at prior authorization effects, delays in care, workforce and reimbursement challenges for genetic counselors, and whether market costs align with the Medicare laboratory fee schedule. The Comptroller General would make recommendations to the HHS Secretary and deliver the report within two years of enactment.
HHS outreach and sequencing report
If enacted, the Secretary of Health and Human Services would convene national organizations, states, hospitals, patient groups, and Medicaid managed care organizations to identify implementation challenges and best practices for Medicaid coverage of genome sequencing. The Secretary would also conduct outreach so stakeholders know about the EPSDT benefit and access to required screenings and treatment. HHS would publish a report on its website within two years of enactment listing State payment amounts for sequencing and information on numbers of children tested and related services.
Sponsors & CoSponsors
Sponsor
Peters
CA • D
Cosponsors
Bilirakis
FL • R
Sponsored 1/15/2026
Veasey
TX • D
Sponsored 1/15/2026
Balderson
OH • R
Sponsored 1/15/2026
Mullin
CA • D
Sponsored 1/15/2026
Carey
OH • R
Sponsored 1/15/2026
Houlahan
PA • D
Sponsored 1/15/2026
Salazar
FL • R
Sponsored 1/15/2026
Auchincloss
MA • D
Sponsored 1/21/2026
Fitzpatrick
PA • R
Sponsored 1/21/2026
Trahan
MA • D
Sponsored 1/30/2026
Lee (FL)
FL • R
Sponsored 1/30/2026
McBride
DE • D
Sponsored 2/3/2026
Kean
NJ • R
Sponsored 2/3/2026
Schrier
WA • D
Sponsored 3/2/2026
Miller (WV)
WV • R
Sponsored 3/2/2026
Roll Call Votes
No roll call votes available for this bill.
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