Section 1 Short title
This Act may be cited as the “No-Cost Breast Examinations in Medicaid Act of 2026”.
No-Cost Breast Examinations in Medicaid Act of 2026
A BILL
To amend title XIX of the Social Security Act to require that diagnostic and supplemental breast examinations are furnished without cost sharing under the Medicaid program, and for other purposes.
Sec. 2 Requiring that diagnostic and supplemental breast examinations are furnished without cost sharing under the Medicaid program
In general—
In general— Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) diagnostic breast examinations and supplemental breast examinations (as such terms are defined in section 1905(ll)); and”
Application to alternative cost sharing— Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:
“(xv) Diagnostic breast examinations and supplemental breast examinations (as such terms are defined in section 1905(ll)).”
Definitions— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection:
“(ll) Definitions relating to breast cancer examinations
“(1) Diagnostic breast examination—The term “diagnostic breast examination” means a medically necessary and appropriate (in accordance with National Comprehensive Cancer Network Guidelines) examination of the breast (including, but not limited to such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound) that is—
“(A) used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
“(B) used to evaluate an abnormality detected by another means of examination.
“(2) Supplemental breast examination—The term “supplemental breast examination” means a medically necessary and appropriate (in accordance with National Comprehensive Cancer Network Guidelines) examination of the breast (including, but not limited to such an examination using breast magnetic resonance imaging or breast ultrasound) that is—
“(A) used to screen for breast cancer when there is no abnormality seen or suspected; and
“(B) furnished based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.”
Inclusion of screening mammography as a mandatory benefit—
In general— Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter preceding clause (i), by inserting “(13)(D),” after “(13)(B),”.
Medical assistance— Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended—
in subparagraph (B), by striking “and” at the end;
in subparagraph (C), by adding “and” at the end; and
by adding at the end the following new subparagraph:
“(D) screening mammography (as defined in section 1861(jj)) assigned a grade of A or B by the United States Preventive Services Task Force;”
Effective date— The amendments made by this section shall apply with respect to medical assistance furnished on or after the date that is 1 year after the date of the enactment of this Act.