HR6494119th CongressWALLET

Territories Health Equity Act of 2025

Sponsored By: Representative Del. Plaskett, Stacey E. [D-VI-At Large]

Introduced

Summary

Aligns U.S. territories with U.S. tax and federal health program rules while creating territory-specific Medicare and Medicaid financing and subsidy changes. The bill would change how hospitals are paid, expand low-income Medicare help, and set a mirror tax system for possessions.

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  • Would create new Disproportionate Share Hospital (DSH) funding mechanisms for the five U.S. territories: Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. It revises DSH target and benchmark calculations to adjust payments to territorial hospitals.
  • Would provide relief from Medicare Part B late enrollment penalties for Puerto Rico and would establish automatic Part B premium and cost-sharing subsidies for eligible low-income residents in the territories. It also requires more reporting, transparency, and applies Affordable Care Act exchange rules to territories that lack functioning exchanges.
  • Would establish a formal mirror code tax system so residents of U.S. possessions have their income taxes determined as if the possession were the United States. Payments under that system would be treated like premium tax credit refunds and the effective date depends on when the Secretary sets up the required mechanism.

Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 0 costs, 1 mixed.

DC Exchange access for possessions

If enacted, the HHS Secretary would set up, within 3 months, a way for bona fide residents of qualifying U.S. possessions to buy coverage through the DC health exchange. If enacted, those residents who are not eligible for employer coverage could get federal premium tax credits and lower cost-sharing like U.S. residents do. If enacted, residents could not claim the U.S. premium tax credit if they get an equivalent possession-level credit or a Treasury payment. If enacted, the Treasury Secretary would pay possessions periodically (at least annually) to offset losses caused by this rule.

Lower Medicare costs for territory enrollees

If enacted, people in U.S. territories who are eligible for Medicare Part D and who are enrolled in territory Medicaid would be treated as eligible for Part D premium and cost-sharing subsidies starting with plan years on or after January 1, 2026. If enacted, the bill would set a Part D blended benchmark floor for territory areas beginning in 2026 so an area’s benchmark is at least 80% of the national average, while also capping it at the lowest State blended benchmark. If enacted, the bill would change how Part B late-enrollment penalty months are counted for some people who lived in Puerto Rico when they became entitled to Part A, which could reduce Part B late-enrollment penalties for affected people for premiums starting after enactment.

More federal payments to territory hospitals

If enacted, starting in fiscal year 2026 the five territories would share a $300,000,000 Medicaid DSH pool for hospitals, with each territory’s share based on its estimated low-income or uninsured population. If enacted, Medicare rules for hospitals in the territories would change for discharges and cost reporting periods on or after October 1, 2025. If enacted, Puerto Rico subsection (d) hospitals would use a substituted DSH numerator for discharges on or after October 1, 2025. If enacted, other territorial hospitals would get higher Medicare target amounts based on their disproportionate patient percentage (10% increase for 15–40%, and 10% plus 0.6 times percentage points above 40%). If enacted, a rebased target amount may replace the otherwise determined amount only when it raises payments, with special rebasing rules through 2030.

Puerto Rico Medicaid match timing changes

If enacted, the bill would change the years referenced in certain Puerto Rico Medicaid matching rate rules. If enacted, it would insert the phrase 'for fiscal years before fiscal year 2026' in one rule and replace '2027' with '2025' in another rule. If enacted, these are narrow timing edits to when specific FMAP limitations apply.

Sponsors & CoSponsors

Sponsor

Del. 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.

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