S 3300 — ANCHOR Act of 2025

Bill Text

• Introduced Introduced in Senate Current html December 02, 2025

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

The bill establishes a state option to provide medical assistance to individuals with serious mental illness or substance use disorder.

• 42 U.S.C. 1396a

  specified individuals (as defined in paragraph (1) of subsection (yy)), subject to the provisions of such subsection;

  This addition allows states to provide medical assistance to a new category of individuals defined as specified individuals.

• 42 U.S.C. 1396a

  For purposes of subsection (a)(10)(A)(ii)(XXIV), the term `specified individual' means an individual-- (A) who is an uninsured individual (as defined in subsection (ss)); (B) whose income (as determined under subsection (e)(14)) does not exceed 100 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved; and (C) who has been determined to have a qualifying condition (as defined in paragraph (2)) by-- (i) a health care provider; or (ii) an entity determined appropriate by the State, which may include-- (I) an emergency department; (II) a clinic certified by the State as a certified community behavioral health clinic in accordance with the criteria described in section 223(a)(1) of the Protecting Access to Medicare Act of 2014; (III) an entity that receives funding from the State to provide mental health or substance use disorder services; (IV) an institution for mental diseases (as defined in section 435.1010 of title 42, Code of Federal Regulations (or a successor regulation)); or (V) a State judicial, law enforcement, or child welfare agency.

  This defines the new category of specified individuals eligible for medical assistance.

• 42 U.S.C. 1396a

  For purposes of paragraph (1)(C), the term `qualifying condition' means any of the following: (A) Serious mental illness. (B) Serious emotional disturbance. (C) Opioid use disorder. (D) Stimulant use disorder (including with respect to cocaine or methamphetamine).

  This establishes specific conditions that qualify an individual for the newly created medical assistance option.

• 42 U.S.C. 1396a

  Medical assistance shall be made available to a specified individual in the same scope and manner as such assistance is made available to individuals described in subsection (a)(10)(A)(i).

  This ensures that medical assistance for specified individuals is aligned with existing assistance provisions.

• 42 U.S.C. 1396a

  Medical assistance shall be made available to a specified individual for an initial continuous 1-year period. At the option of the State, the State may extend the availability of such assistance to such individual for subsequent continuous 1-year periods, provided that, prior to each such extension, the State redetermines that such individual continues to be a specified individual.

  This outlines the duration and conditions under which medical assistance can continue for specified individuals.

• 42 U.S.C. 1396a

  A State shall, as a condition of exercising the State's option to make medical assistance available to specified individuals-- (A) ensure such individuals have a care plan developed within 60 days of enrolling for such assistance by a physician, primary care provider, emergency department, clinical practice or clinical group practice, rural clinic, community health center, certified community behavioral health clinic, or other health care provider that is determined by the State to be qualified to develop such a plan; and (B) agree to report the behavioral health measures of the Core Set of Adult Health Care Quality Measures for Medicaid with respect to such individuals in accordance with section 1139B.

  This establishes requirements for care planning and reporting for states that opt to provide assistance to specified individuals.

Action History

1. December 02, 2025

   Introduced in Senate

2. December 02, 2025

   Read twice and referred to the Committee on Finance.

Sponsors

• Marsha Blackburn · Primary

Subjects