How HR 4569 changes current law

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill mandates no-cost coverage for human milk fortifier under both Medicaid and the Children's Health Insurance Program, effective January 1, 2026.

• 42 U.S.C. 1396a(a)(10)(A)

  and (30) → (30), and (32)

  This change adds coverage for human milk fortifier to the mandatory benefits under Medicaid.

• 42 U.S.C. 1396a(a)(10)(C)(iv)

  and (17) → (17), and (32)

  This change includes human milk fortifier in the medically needy category for Medicaid coverage.

• 42 U.S.C. 1396u-7(b)

  Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless, beginning on January 1, 2026, such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) human milk fortifier described in section 1905(a)(32).

  This change prohibits states from offering benchmark coverage without including no-cost human milk fortifier starting January 1, 2026.

• 42 U.S.C. 1396d

  and → beginning January 1, 2026, human milk fortifier (as described in subsection (kk)); and

  This change establishes human milk fortifier as a defined benefit under Medicaid starting January 1, 2026.

• 42 U.S.C. 1396d

  Human Milk Fortifier.--For purposes of subsection (a)(32), the term `human milk fortifier' means a donor human milk-derived product that is furnished to an infant under 1 year of age if a specified professional determines that such donor human milk-derived product is medically necessary for the infant because--... (detailed definition follows)

  This establishes a definition for human milk fortifier, describing its medical necessity criteria.

• 42 U.S.C. 1396o

  beginning January 1, 2026, human milk fortifier (as described in section 1905(a)(32));

  This mandates that human milk fortifier cannot have any cost-sharing requirements under Medicaid starting January 1, 2026.

• 42 U.S.C. 1397cc

  and (8) → , (8), and (13)

  This extends coverage in the Children's Health Insurance Program to include human milk fortifiers.

• 42 U.S.C. 1397cc(c)

  Required coverage of human milk fortifier.--The child health assistance provided to a targeted low-income child shall include coverage of human milk fortifier (as described in section 1905(a)(32)).

  This legally requires coverage for human milk fortifier in the Children's Health Insurance Program.

• 42 U.S.C. 1397cc(e)(2)

  human milk fortifier described in section 1905(a)(32),

  This change prohibits cost sharing for human milk fortifier under the Children's Health Insurance Program.

• 42 U.S.C. 300gg-11 et seq.

  No-Cost Coverage of Human Milk Fortifier. A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall provide coverage for, and shall not impose any cost sharing requirements for, human milk fortifier (as described in section 1905(a)(kk) of the Social Security Act).

  This mandates no-cost coverage for human milk fortifier in group and individual health plans.