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119-hr-7118119th CongressWALLET

Genomic Answers for Children’s Health Act of 2026

Sponsored By: Representative Peters, Scott H. [D-CA-50]

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, Scott H. [D-CA-50]

CA • D

Cosponsors

  • Rep. Riley, Josh [D-NY-19]

    NY • D

    Sponsored 10/1/2026

  • Rep. Bilirakis, Gus M. [R-FL-12]

    FL • R

    Sponsored 1/15/2026

  • Rep. Veasey, Marc A. [D-TX-33]

    TX • D

    Sponsored 1/15/2026

  • Rep. Balderson, Troy [R-OH-12]

    OH • R

    Sponsored 1/15/2026

  • Rep. Mullin, Kevin [D-CA-15]

    CA • D

    Sponsored 1/15/2026

  • Rep. Carey, Mike [R-OH-15]

    OH • R

    Sponsored 1/15/2026

  • Rep. Houlahan, Chrissy [D-PA-6]

    PA • D

    Sponsored 1/15/2026

  • Rep. Salazar, Maria Elvira [R-FL-27]

    FL • R

    Sponsored 1/15/2026

  • Rep. Auchincloss, Jake [D-MA-4]

    MA • D

    Sponsored 1/21/2026

  • Rep. Fitzpatrick, Brian K. [R-PA-1]

    PA • R

    Sponsored 1/21/2026

  • Rep. Trahan, Lori [D-MA-3]

    MA • D

    Sponsored 1/30/2026

  • Rep. Lee, Laurel M. [R-FL-15]

    FL • R

    Sponsored 1/30/2026

  • Rep. McBride, Sarah [D-DE-At Large]

    DE • D

    Sponsored 2/3/2026

  • Rep. Kean, Thomas H. [R-NJ-7]

    NJ • R

    Sponsored 2/3/2026

  • Rep. Schrier, Kim [D-WA-8]

    WA • D

    Sponsored 3/2/2026

  • Rep. Miller, Carol D. [R-WV-1]

    WV • R

    Sponsored 3/2/2026

  • Rep. Matsui, Doris O. [D-CA-7]

    CA • D

    Sponsored 4/14/2026

  • Rep. Begich, Nicholas J. [R-AK-At Large]

    AK • R

    Sponsored 4/14/2026

  • Rep. Landsman, Greg [D-OH-1]

    OH • D

    Sponsored 5/11/2026

  • Rep. Barrett, Tom [R-MI-7]

    MI • R

    Sponsored 5/22/2026

  • Rep. Tonko, Paul [D-NY-20]

    NY • D

    Sponsored 5/22/2026

  • Rep. Bacon, Don [R-NE-2]

    NE • R

    Sponsored 6/29/2026

  • Rep. Pocan, Mark [D-WI-2]

    WI • D

    Sponsored 6/29/2026

  • Rep. Gottheimer, Josh [D-NJ-5]

    NJ • D

    Sponsored 8/10/2026

  • Rep. Lawler, Michael [R-NY-17]

    NY • R

    Sponsored 8/10/2026

  • Rep. Himes, James A. [D-CT-4]

    CT • D

    Sponsored 9/21/2026

  • Rep. Smucker, Lloyd [R-PA-11]

    PA • R

    Sponsored 9/21/2026

Roll Call Votes

No roll call votes available for this bill.

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