Bridge to Medicaid Act of 2025
Bridge to Medicaid Act of 2025 aims to make health coverage more affordable for low-income people in states that have not expanded Medicaid. It does this by expanding and intensifying financial assistance under the Affordable Care Act (ACA) for plan years 2026–2028, creating new enrollment provisions, offering additional benefits for low-income enrollees, and providing targeted funding for outreach, navigator support, and federal matching funds (FMAP) for Medicaid. The core idea is to lower out-of-pocket costs, broaden eligibility for tax credits, and temporarily boost federal support to both ACA markets and Medicaid in non-expansion states, thereby reducing barriers to obtaining affordable coverage. Key elements include: (1) dramatically reducing cost-sharing for certain low-income enrollees in qualified health plans (QHPs) during 2026–2028, with a mechanism to pay issuers to cover most of the plan costs; (2) creating special enrollment periods and open enrollment enhancements for low-income populations in those states; (3) adding extra benefits (like non-emergency transportation and related services) for low-income individuals in 2026–2027 with federal payments to issuers; (4) expanding premium tax credits for 2026–2028 to improve affordability, including for some low-income employees; (5) temporary increases in FMAP for newly eligible Medicaid adults through 2028 and then 90% thereafter; and (6) substantial outreach, navigator, and funding provisions to support these changes.
Key Points
- 1Dramatic reduction of cost sharing for certain low-income QHP enrollees (specified enrollees) for 2026–2028, aiming for the plan to cover 99% of total allowed costs and enrollees paying roughly 1% of costs; includes a special rule for 2025 to treat 138% FPL households as 100% for purposes of this section.
- 2Special enrollment period and enhanced open enrollment for months 2026–2028 for individuals described as low-income under the act, improving access to coverage outside the usual enrollment windows.
- 3Additional benefits for plan years 2026–2027 (beyond the standard ACA essential benefits) for certain low-income individuals, including non-emergency transportation and related services, with issuers paid by the federal government to cover these costs and eliminate cost-sharing or provider restrictions.
- 4Expanded funding and outreach provisions, including a new outreach/education mission for exchanges in non-expansion states, plus dedicated funding (about $105 million across 2026–2028) and a navigator grant program to help states/organizations reach eligible populations.
- 5Temporary expansion of the premium tax credits (ACA 36B) for 2026–2028: making premium credits more widely available, removing certain income-based limits, and extending eligibility for individuals who otherwise would not qualify; adjustments also apply to related employer-based coverage rules and recapture limitations.
- 6Substantial FMAP increases for Medicaid: raises the federal matching rate to 93% for calendar quarters in 2026–2028 and 90% for 2029 onward for newly eligible mandatory Medicaid individuals, increasing federal support to expand or maintain coverage in non-expansion states.
- 7Funding authorization: new and expanded appropriations to support the above provisions, including specific sums for 2026 and years 2027–2028, plus ongoing FMAP-driven funding for Medicaid.