Territories Health Equity Act of 2025
Sponsored By: Representative Plaskett, Stacey E. [D-VI-At Large]
Introduced
Summary
Would increase federal health funding and program parity for the five U.S. territories. This bill would change Medicaid and Medicare rules, expand hospital DSH payments, extend Part D and Exchange subsidy access, and require territory-level data publication.
Show full summary
- Families and low-income residents in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa would gain ways to buy Exchange-style coverage with premium tax credits and lower cost sharing through a DC Exchange mechanism or alternate Treasury arrangements.
- Medicare beneficiaries in the territories would see automatic Part D premium and cost-sharing subsidies for certain low-income enrollees beginning Jan 1, 2026 and phased elimination of some Medicare Part B late enrollment penalties for certain Puerto Rico residents in 2025–2026.
- Hospitals and safety-net providers in the territories would get expanded Disproportionate Share Hospital allotments and a new DSH adjustment that raises payments based on each hospital's disproportionate patient percentage with larger increases above 40%.
- Territorial Medicaid programs would have the general Medicaid funding cap ended in FY2026 and a shortened or removed Federal Medical Assistance Percentage limit for Puerto Rico, with transition rules in 2025–2026.
- HHS would be required to publish territory-level Medicaid and CHIP spending and related data within 180 days and produce a report quantifying uninsured populations and federal assistance denied to each territory.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
5 provisions identified: 2 benefits, 0 costs, 3 mixed.
More hospital payments for territories
For FY2026 the bill would set aside $300 million in Medicaid disproportionate share hospital (DSH) allotments and split it across Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Each territory's FY2026 share would equal its estimated low-income or uninsured count divided by the total for all territories, times $300 million. For hospital cost reporting periods starting October 1, 2025, the bill would also raise territory hospital Medicare DSH target amounts based on each hospital's disproportionate patient percentage (DP%): a 10% boost if DP% is 15–40%, and 10% plus additional adjustments for DP% above 40%. These changes would raise DSH support and targeted hospital payments in the territories.
Medicare fixes for territory residents
The bill would make several Medicare changes for territory residents. Starting with plan years on or after January 1, 2026, people eligible for Medicare Part D who are enrolled in a territory Medicaid plan would be treated as eligible for Part D premium and cost‑sharing subsidies. For certain people who became entitled to Part A within the four years before enactment and who lived in Puerto Rico on that date, months in the next five years would count for Part B enrollment rules, helping avoid late‑enrollment penalties for premiums beginning on enactment. The bill would also set rules for Medicare Advantage area benchmarks in territories for plan years beginning 2026, requiring benchmarks to be at least 80% of the national average but not higher than the lowest State or DC benchmark for the year.
Marketplace access and tax rules for possessions
The bill would require HHS, Treasury, and OPM to set up a way for bona fide residents of Treasury‑certified U.S. possessions that have no Exchange plans to get coverage like the DC Exchange within three months of enactment. Eligible residents who cannot get employer coverage would be able to receive premium tax credits, reduced cost sharing, and advance payments. The bill would bar people who get an equivalent possession tax credit or a Treasury possession distribution payment from also claiming the federal premium tax credit, and it would require Treasury to make periodic payments to possessions to offset losses from DC Exchange access if certain mirror‑code or distribution plans are in place.
Changes to territory Medicaid funding
This bill would remove the long-standing territory Medicaid funding cap starting in fiscal year 2026. It would also change which years certain Puerto Rico FMAP limits apply to, replacing a 2027 reference with 2025 and limiting some FMAP rules to years before FY2026. At the same time, the bill would confine certain earlier "enhanced allotment" rules to periods before 2026, effectively ending prospective enhanced allotment authority after 2025. These changes would shift how federal Medicaid money is available to territories and change timing and labels for matching rules.
Territory Medicaid and CHIP data reports
Not later than 180 days after enactment, the bill would require HHS to publish and periodically update territory‑level Medicaid and CHIP information on the CMS website. Required items include income eligibility levels, enrollment counts, waivers and State plan amendments, federal and non‑federal shares of spending, how services are delivered, and CHIP design. This would give residents and policymakers clearer, public data about territory programs.
Sponsors & CoSponsors
Sponsor
Plaskett, Stacey E. [D-VI-At Large]
VI • D
Cosponsors
Del. Radewagen, Aumua Amata Coleman [R-AS-At Large]
AS • R
Sponsored 12/5/2025
Rescom. Hernández, Pablo Jose [D-PR-At Large]
PR • D
Sponsored 12/5/2025
Del. Moylan, James C. [R-GU-At Large]
GU • R
Sponsored 12/5/2025
Del. King-Hinds, Kimberlyn [R-MP-At Large]
MP • R
Sponsored 12/5/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov