Medicare Equity Model Testing Act

Summary#

The John Lewis Equality in Medicare and Medicaid Treatment Act of 2026 would amend section 1115A of the Social Security Act, which covers models tested through the Center for Medicare and Medicaid Innovation. Its stated goal is to improve access to care for Medicare and Medicaid beneficiaries; the bill does not guarantee that result.

  • The Secretary of Health and Human Services would have to consult three named federal health offices before selecting models, and models starting on or after January 1, 2027, would have to address health equity as well as improve access to care.
  • The Secretary would have to select a social determinants of health payment model for testing, with testing to begin by December 31, 2027. The model would test four types of payment and service changes, in a region the Secretary considers appropriate.
  • Model selection and expansion decisions would have to take account of effects on health equity and disparities, including minority and rural health disparities.
  • Reports submitted after the bill became law would have to cover relevant interventions, estimated federal savings, and intervention effectiveness.
  • The supplied materials do not include the current text of the amended Act, so the full current-law rules cannot be verified here.

What it means for you#

  • Medicare and Medicaid beneficiaries: The bill would change how federal officials select and assess certain test models. It would not directly change your eligibility, benefits, or right to care, and it does not guarantee that a model will operate where you live.
  • People with behavioral health conditions, people in underserved areas, and Medicaid-eligible pregnant or postpartum women: The required model would test specified payment and service innovations aimed at these areas or groups. Testing would be limited to a region chosen by the Secretary; the bill does not promise that every person in those groups would receive a service.
  • Providers and suppliers: Decisions about models would have to consider effects on providers and suppliers serving high-risk patients or operating in underserved areas. The bill does not establish a process for providers to apply or require them to take part.
  • Federal officials: The Secretary would have to consult the named offices before model selection and include specified information in reports. The bill does not create a new agency.

Money#

No publicly available information on the bill’s estimated public cost.

  • The bill requires selection and testing of a model by a deadline, but provides no cost estimate or specific appropriation in the supplied text.
  • It requires reports to include estimated federal savings from reducing disparities, improving health equity, or addressing social determinants of health. That is a reporting requirement, not a promise that savings will occur.

What is unclear#

  • The bill does not specify the model’s budget, how it would be paid for, or how many people or providers it would involve.
  • It leaves the choice of region to the Secretary and does not set criteria for that choice.
  • The phrase “applicable individuals” in one part of the required model is not defined in the supplied bill text.
  • The bill does not set application rules, participant selection rules, timelines beyond the testing start deadline, or an appeals process.
  • The supplied materials do not include the current text of section 1115A, so how the new criteria fit with all existing model-selection and expansion rules cannot be fully checked.

Case for#

  • A possible argument for the bill is that model decisions would have to consider whether care changes reduce disparities, rather than focusing only on other measures.
  • Consulting offices focused on minority health, rural health, and women’s health could bring relevant expertise into model selection.
  • Testing approaches for behavioral health, underserved areas, and pregnancy and postpartum care could help officials learn which changes work before considering wider use.
  • Required reporting could make the effects and estimated savings of these interventions more visible.

Case against#

  • The bill requires equity and disparity considerations but does not define how officials should measure them or resolve conflicts among criteria.
  • The Secretary chooses the region, and the bill sets few details about who will participate or how services will be delivered.
  • The bill requires testing and reporting without stating the cost or the resources needed.
  • The bill’s required topics do not ensure that a tested model will improve access or reduce disparities; those are aims to be assessed, not guaranteed outcomes.