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119-hr-10874119th CongressWALLET

Medicare Low Income Subsidy Equality Act of 2026

Sponsored By: Representative Rescom. Hernández, Pablo Jose [D-PR-At Large]

Introduced

Summary

Equalize Medicare Part D low‑income premium and cost‑sharing subsidies for Puerto Rico and other U.S. territories. This bill would also create a new territory‑focused Medicaid funding formula and multi‑year growth schedule to align territorial funding with established federal growth rules.

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  • Residents of Puerto Rico and other territories would use the poverty line for the 48 contiguous States and DC to qualify for the Low‑Income Subsidy in Part D, expanding the rule that determines affordability and taking effect January 1, 2027.
  • Territorial Medicaid programs get a new computation path. Monthly territory payments start by linking a 2026 state baseline to a factor based on the highest State FMAP for FY 2024, with a special 2027 quarterly split and subsequent annual growth tied to the percentage in section 1108(f).
  • The Centers for Medicare & Medicaid Services would no longer apply the old subparagraph (F) limitation when calculating Part D subsidies for non‑state residents, creating a uniform standard for affordability calculations.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 0 benefits, 0 costs, 2 mixed.

More Medicare drug help for territories

If enacted, the bill would change how Medicare Part D low-income drug subsidies are decided for people who live outside the 50 states and D.C. Starting January 1, 2027, those applicants would use the poverty line for the 48 contiguous states and D.C. when determining eligibility. The bill would also remove a prior statutory constraint on how the Secretary applies subsidy rules, broadening the Secretary’s authority for these cases. The text does not say how many people would gain or lose eligibility.

New Medicaid funding formula for territories

If enacted, the bill would change how federal Medicaid funding is computed for Puerto Rico and other U.S. territories starting in 2027. The monthly territorial payment would be based on the territory’s 2026 amount, multiplied by 100% minus the highest state FMAP for FY2024, then grown each year by the bill’s annual factor. The bill also revises state allocations for FY2027: the first quarter would use 25% of the prior year amount adjusted by an annual increase, and the last three quarters would use an aggregate amount equal to three times a specified base (then four times that base in 2028 with the usual annual increase). These calculation and funding-rule changes would take effect on the date of enactment and apply beginning in FY2027.

Sponsors & CoSponsors

Sponsor

Rescom. Hernández, Pablo Jose [D-PR-At Large]

PR • D

Cosponsors

  • Rep. Ruiz, Raul [D-CA-25]

    CA • D

    Sponsored 11/2/2026

  • Del. Moylan, James C. [R-GU-At Large]

    GU • R

    Sponsored 10/22/2026

  • Rep. Soto, Darren [D-FL-9]

    FL • D

    Sponsored 10/22/2026

Roll Call Votes

No roll call votes available for this bill.

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