I 
119TH CONGRESS 
1ST SESSION H. R. 3257 
To ensure affordable health insurance coverage for low-income individuals 
in States that have not expanded Medicaid. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 7, 2025 
Ms. SEWELL (for herself and Mr. FIGURES) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To ensure affordable health insurance coverage for low-in-
come individuals in States that have not expanded Med-
icaid. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Bridge to Medicaid 
Act of 2025’’. 
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SEC. 2. ENSURING AFFORDABILITY OF COVERAGE FOR 
CERTAIN LOW-INCOME POPULATIONS. 
(a) REDUCING COST SHARING UNDER QUALIFIED 
HEALTH PLANS.—Section 1402 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18071) is amended— 
(1) in subsection (b)— 
(A) in paragraph (2), by inserting ‘‘(or, 
with respect to plan years 2026, 2027, and 
2028, whose household income does not exceed 
400 percent of the poverty line for a family of 
the size involved)’’ before the period; and 
(B) in the matter following paragraph (2), 
by adding at the end the following new sen-
tence: ‘‘In the case of an individual who is de-
termined at any point to have a household in-
come for 2025 that does not exceed 138 percent 
of the poverty line for a family of the size in-
volved, such individual shall, for each month 
during such year, be treated as having a house-
hold income equal to 100 percent for purposes 
of applying this section.’’; and 
(2) in subsection (c)— 
(A) in paragraph (1)(A), in the matter 
preceding clause (i), by inserting ‘‘, with respect 
to eligible insureds (other than, with respect to 
plan years 2026, 2027, and 2028, specified en-
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rollees (as defined in paragraph (6)(C))),’’ after 
‘‘first be achieved’’; 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘with re-
spect to eligible insureds (other than, with re-
spect to plan years 2026, 2027, and 2028, spec-
ified enrollees)’’ after ‘‘under the plan’’; 
(C) in paragraph (3)— 
(i) in subparagraph (A), by striking 
‘‘this subsection’’ and inserting ‘‘paragraph 
(1) or (2)’’; and 
(ii) in subparagraph (B), by striking 
‘‘this section’’ and inserting ‘‘paragraphs 
(1) and (2)’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL RULE FOR SPECIFIED ENROLL-
EES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which the issuer of 
a qualified health plan to which this section ap-
plies shall reduce cost-sharing under the plan 
with respect to months occurring during plan 
years 2026, 2027, and 2028 for enrollees who 
are specified enrollees (as defined in subpara-
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graph (C)) in a manner sufficient to increase 
the plan’s share of the total allowed costs of 
benefits provided under the plan to 99 percent 
of such costs. 
‘‘(B) METHODS
FOR
REDUCING
COST 
SHARING.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making reductions 
under this paragraph shall notify the Sec-
retary of such reductions and the Sec-
retary shall, out of funds made available 
under clause (ii), make periodic and timely 
payments to the issuer equal to 12 percent 
of the total allowed costs of benefits pro-
vided under each such plan to specified en-
rollees during plan years 2026, 2027, and 
2028. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there are ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i). 
‘‘(C) SPECIFIED
ENROLLEE
DEFINED.— 
For purposes of this section, the term ‘specified 
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enrollee’ means, with respect to a plan year, an 
eligible insured who is determined at any point 
to have a household income for such plan year 
that does not exceed 138 percent of the poverty 
line for a family of the size involved. Such in-
sured shall be deemed to be a specified enrollee 
for each month in such plan year.’’. 
(b) OPEN ENROLLMENTS APPLICABLE TO CERTAIN 
LOWER-INCOME POPULATIONS.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) with respect to a qualified health plan 
with respect to which section 1402 applies, for 
months occurring during the period beginning 
on January 1, 2026, and ending on December 
31, 2028, enrollment periods described in sub-
paragraph (A) of paragraph (8) for individuals 
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described in subparagraph (B) of such para-
graph.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN LOW-INCOME POPULATIONS.— 
‘‘(A) IN GENERAL.—The enrollment period 
described in this paragraph is, in the case of an 
individual described in subparagraph (B), the 
continuous period beginning on the first day 
that such individual is so described. 
‘‘(B) INDIVIDUAL
DESCRIBED.—For pur-
poses of subparagraph (A), an individual de-
scribed in this subparagraph is an individual— 
‘‘(i) with a household income that 
does not exceed 138 percent of the poverty 
line for a family of the size involved; and 
‘‘(ii) who is not eligible for minimum 
essential coverage (as defined in section 
5000A(f) of the Internal Revenue Code of 
1986), other than for coverage described in 
any of subparagraphs (B) through (E) of 
paragraph (1) of such section.’’. 
(c) ADDITIONAL BENEFITS FOR CERTAIN LOW-IN-
COME INDIVIDUALS FOR PLAN YEARS 2026 AND 2027.— 
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Section 1301(a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18021(a)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C)(iv), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) provides, with respect to a plan of-
fered in the silver level of coverage to which sec-
tion 1402 applies during plan year 2026 and 
2027, for benefits described in paragraph (5) in 
the case of an individual who has a household 
income that does not exceed 138 percent of the 
poverty line for a family of the size involved, 
and who is eligible to receive cost-sharing re-
ductions under section 1402.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) ADDITIONAL
BENEFITS
FOR
CERTAIN 
LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2026 AND 
2027.— 
‘‘(A) IN GENERAL.— 
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‘‘(i) BENEFITS.—For purposes of 
paragraph (1)(D), the benefits described in 
this paragraph to be provided by a quali-
fied health plan are benefits consisting 
of— 
‘‘(I) 
non-emergency 
medical 
transportation services (as described 
in section 1902(a)(4) of the Social Se-
curity Act) for which Federal pay-
ments would have been available 
under title XIX of the Social Security 
Act had such services been furnished 
to an individual enrolled under a 
State plan (or waiver of such plan) 
under such title; and 
‘‘(II) services described in sub-
section (a)(4)(C) of section 1905 of 
such Act for which Federal payments 
would have been so available; 
which are not otherwise provided under 
such plan as part of the essential health 
benefits package described in section 
1302(a). 
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‘‘(ii) CONDITION
ON
PROVISION
OF 
BENEFITS.—Benefits described in this 
paragraph shall be provided— 
‘‘(I) without any restriction on 
the choice of a qualified provider from 
whom an individual may receive such 
benefits; and 
‘‘(II) without any imposition of 
cost sharing. 
‘‘(B) PAYMENTS FOR ADDITIONAL BENE-
FITS.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making payments for 
services described in subparagraph (A) fur-
nished to individuals described in para-
graph (1)(D) during plan year 2026 or 
2027 shall notify the Secretary of such 
payments and the Secretary shall, out of 
funds made available under clause (ii), 
make periodic and timely payments to the 
issuer equal to payments for such services 
so furnished. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there is ap-
propriated, out of any money in the Treas-
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ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i).’’. 
(d) EDUCATION AND OUTREACH ACTIVITIES.— 
(1) IN GENERAL.—Section 1321(c) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
cational activities for purposes of informing in-
dividuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security 
Act who reside in States that have not ex-
pended amounts under a State plan (or waiver 
of such plan) under title XIX of such Act for 
all such individuals about qualified health plans 
offered through the Exchange, including by in-
forming such individuals of the availability of 
coverage under such plans and financial assist-
ance for coverage under such plans. Such out-
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reach and educational activities shall be pro-
vided in a manner that is culturally and linguis-
tically appropriate to the needs of the popu-
lations being served by the Exchange (including 
hard-to-reach populations, such as racial and 
sexual minorities, limited English proficient 
populations, individuals residing in areas where 
the unemployment rates exceeds the national 
average unemployment rate, individuals in rural 
areas, veterans, and young adults). 
‘‘(B) LIMITATION
ON
USE
OF
FUNDS.— 
Funds appropriated under this paragraph shall 
not be used to promote any health insurance 
coverage other than qualified health plans. 
‘‘(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated, out of 
any money in the Treasury not otherwise ap-
propriated, to remain available until expended, 
$105,000,000 for fiscal year 2026 to carry out 
this paragraph, of which— 
‘‘(i) $15,000,000 shall be used to 
carry out this paragraph in fiscal year 
2026; and 
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‘‘(ii) $30,000,000 shall be used to 
carry out this paragraph for each of fiscal 
years 2027 through 2028.’’. 
(2) NAVIGATOR PROGRAM.—Section 1311(i) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18031(i)) is amended— 
(A) in paragraph (1)— 
(i) by striking ‘‘An Exchange’’ and in-
serting the following: 
‘‘(A) IN GENERAL.—An Exchange’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(B) GRANTS
FOR
ELIGIBLE
ENTITIES 
WITH RESPECT TO CERTAIN STATES.—The Sec-
retary shall establish a program to award 
grants to entities described in paragraph (2) to 
carry out the duties described in paragraph (3) 
in one or more States that do not provide under 
the State plan under title XIX of the Social Se-
curity Act (or a waiver of such plan) bench-
mark coverage described in section 1937(b)(1) 
of such Act or benchmark equivalent coverage 
described in section 1937(b)(2) of such Act to 
all 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of such Act.’’; and 
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(B) in paragraph (6)— 
(i) by striking ‘‘Grants under’’ and in-
serting the following: ‘‘ 
‘‘(A) STATE EXCHANGES.—Grants under’’; 
and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) FEDERAL
EXCHANGES; GRANTS
TO 
ELIGIBLE ENTITIES WITH RESPECT TO CERTAIN 
STATES.—For purposes of carrying out this 
subsection, with respect to an Exchange estab-
lished and operated by the Secretary within a 
State pursuant to section 1321(c) and with re-
spect to grants under paragraph (1)(B), the 
Secretary 
shall 
obligate 
not 
less 
than 
$10,000,000 out of amounts collected through 
the user fees on participating health insurance 
issuers pursuant to section 156.50 of title 45, 
Code of Federal Regulations (or any successor 
regulations) for fiscal year 2026, and not less 
than $20,000,000 for each of fiscal years 2027 
and 2028. Such amount so obligated for a fiscal 
year shall remain available until expended.’’. 
(e) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Secretary of Health 
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and Human Services for fiscal year 2026, out of any 
money in the Treasury not otherwise appropriated, 
$65,000,000, to remain available until expended, for pur-
poses of carrying out the provisions of, and the amend-
ments made by, this section. 
SEC. 3. TEMPORARY EXPANSION OF HEALTH INSURANCE 
PREMIUM TAX CREDITS FOR CERTAIN LOW- 
INCOME POPULATIONS. 
(a) IN GENERAL.—Section 36B of the Internal Rev-
enue Code of 1986 is amended by redesignating subsection 
(h) as subsection (i) and by inserting after subsection (g) 
the following new subsection: 
‘‘(h) CERTAIN TEMPORARY RULES BEGINNING IN 
2026.—With respect to any taxable year beginning after 
December 31, 2025, and before January 1, 2029— 
‘‘(1) ELIGIBILITY
FOR
CREDIT
NOT
LIMITED 
BASED ON INCOME.—Subsection (c)(1)(A) shall be 
applied without regard to ‘equals or exceeds 100 
percent but’. 
‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME
EMPLOYEES
OFFERED
EMPLOYER-PROVIDED 
COVERAGE.—In the case of an individual whose 
household income does not exceed 138 percent of the 
poverty line for a family of the size involved, clause 
(i) of subsection (c)(2)(C) shall be applied (including 
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in the case of any individual described in the last 
sentence of such clause) without regard to subclause 
(II) thereof. 
‘‘(3) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME EMPLOYEES OFFERED QUALIFIED SMALL EM-
PLOYER
HEALTH
REIMBURSEMENT
ARRANGE-
MENTS.—A qualified small employer health reim-
bursement arrangement shall not be treated as con-
stituting affordable coverage for an employee (or any 
spouse or dependent of such employee) for any 
months of a taxable year if the employee’s household 
income for such taxable year does not exceed 138 
percent of the poverty line for a family of the size 
involved. 
‘‘(4) LIMITATIONS ON RECAPTURE.— 
‘‘(A) IN GENERAL.—In the case of a tax-
payer whose household income is less than 200 
percent of the poverty line for the size of the 
family involved for the taxable year, the amount 
of the increase under subsection (f)(2)(A) shall 
in no event exceed $300 (one-half of such 
amount in the case of a taxpayer whose tax is 
determined under section 1(c) for the taxable 
year). 
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‘‘(B) LIMITATION ON INCREASE FOR CER-
TAIN NON-FILERS.—In the case of any taxpayer 
who would not be required to file a return of 
tax for the taxable year but for any require-
ment to reconcile advance credit payments 
under subsection (f), if an Exchange established 
under title I of the Patient Protection and Af-
fordable Care Act has determined that— 
‘‘(i) such taxpayer is eligible for ad-
vance payments under section 1412 of 
such Act for any portion of such taxable 
year, and 
‘‘(ii) such taxpayer’s household in-
come for such taxable year is projected not 
to exceed 138 percent of the poverty line 
for a family of the size involved, 
subsection (f)(2)(A) shall not apply to such tax-
payer for such taxable year and such taxpayer 
shall not be required to file such return of tax. 
‘‘(C) INFORMATION
PROVIDED
BY
EX-
CHANGE.—The information required to be pro-
vided by an Exchange to the Secretary and to 
the taxpayer under subsection (f)(3) shall in-
clude such information as is necessary to deter-
mine whether such Exchange has made the de-
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terminations described in clauses (i) and (ii) of 
subparagraph (B) with respect to such tax-
payer.’’. 
(b) EMPLOYER SHARED RESPONSIBILITY PROVISION 
NOT APPLICABLE WITH RESPECT TO CERTAIN LOW-IN-
COME TAXPAYERS RECEIVING PREMIUM ASSISTANCE.— 
Section 4980H(c)(3) of the Internal Revenue Code of 
1986 is amended to read as follows: 
‘‘(3) APPLICABLE PREMIUM TAX CREDIT AND 
COST-SHARING REDUCTION.— 
‘‘(A) IN GENERAL.—The term ‘applicable 
premium tax credit and cost-sharing reduction’ 
means— 
‘‘(i) any premium tax credit allowed 
under section 36B, 
‘‘(ii) any cost-sharing reduction under 
section 1402 of the Patient Protection and 
Affordable Care Act, and 
‘‘(iii) any advance payment of such 
credit or reduction under section 1412 of 
such Act. 
‘‘(B) EXCEPTION WITH RESPECT TO CER-
TAIN
LOW-INCOME
TAXPAYERS.—Such term 
shall not include any premium tax credit, cost- 
sharing reduction, or advance payment other-
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wise described in subparagraph (A) if such 
credit, reduction, or payment is allowed or paid 
for a taxable year of an employee (beginning 
after December 31, 2025, and before January 
1, 2029) with respect to which— 
‘‘(i) an Exchange established under 
title I of the Patient Protection and Af-
fordable Care Act has determined that 
such employee’s household income for such 
taxable year is projected to not exceed 138 
percent of the poverty line for a family of 
the size involved, or 
‘‘(ii) such employee’s household in-
come for such taxable year does not exceed 
138 percent of the poverty line for a family 
of the size involved.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
SEC. 4. FURTHER INCREASE IN FMAP FOR MEDICAL AS-
SISTANCE FOR NEWLY ELIGIBLE MANDA-
TORY INDIVIDUALS. 
Section 1905(y)(1) of the Social Security Act (42 
U.S.C. 1396d(y)(1)) is amended— 
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