This bill changes the Social Security Act so that Medicaid clearly covers whole genome sequencing (WGS) and whole exome sequencing (WES) for children with certain medical needs. It says WGS and WES are covered when a doctor or other provider orders them as a first-tier test for a child suspected of having a genetic disorder, a rare disease, or a condition of unknown origin, including congenital anomalies, global developmental delay, or intellectual disability. The bill defines WGS/WES to include sequencing of DNA bases, testing of first-degree relatives if needed for diagnosis, and the analysis, interpretation, and data report that come from the test. It requires that payment for these tests be made separately and not bundled with other medical payments. The Department of Health and Human Services (HHS) must convene national organizations and stakeholders, do outreach, and publish a public report within 2 years that lists payment amounts by State and information on how many children received sequencing and related outcomes. The Government Accountability Office (Comptroller General) must collect feedback and assess issues such as prior authorization, workforce and genetic counselor reimbursement, and how market costs compare to federal laboratory fee schedules, and then make recommendations. The bill takes effect January 1, 2027. It was introduced in the House on January 15, 2026, and referred to the House Committee on Energy and Commerce.
No publicly available information on the total federal or state cost of implementing this change. The bill does require HHS to publish State-by-State payment amounts for WGS/WES within 2 years. The Comptroller General will assess market costs, lab fee schedule alignment, and reimbursement issues and report findings and recommendations.
No publicly available information in the bill text about supporters' arguments or claimed benefits. The bill's sponsors are listed in the bill metadata.
No publicly available information in the bill text about opponents' arguments or concerns.