410 
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). 
‘‘(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— 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00410
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
411 
‘‘(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-
terminations described in clauses (i) and (ii) of 
subparagraph (B) with respect to such tax-
payer.’’. 
(2) EMPLOYER SHARED RESPONSIBILITY PRO-
VISION NOT APPLICABLE WITH RESPECT TO CER-
TAIN LOW-INCOME TAXPAYERS RECEIVING PREMIUM 
ASSISTANCE.—Section 4980H(c)(3) is amended to 
read as follows: 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00411
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
412 
‘‘(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-
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 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00412
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
413 
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.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to taxable years begin-
ning after December 31, 2025. 
(g) FURTHER INCREASE IN FMAP FOR MEDICAL 
ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDI-
VIDUALS.—Section 1905(y)(1) of the Social Security Act 
(42 U.S.C. 1396d(y)(1)) is amended— 
(1) in subparagraph (D), by striking at the end 
‘‘and’’; 
(2) in subparagraph (E), by striking ‘‘2020 and 
each year thereafter.’’ and inserting ‘‘2020, 2021, 
2022, 2023, 2024, and 2025;’’; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(F) 93 percent for calendar quarters in 
2026, 2027, and 2028; and 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00413
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
414 
‘‘(G) 90 percent for calendar quarters in 
2029 and each year thereafter.’’. 
SEC. 50003. FREEZE OF PREMIUM ADJUSTMENT PERCENT-
AGE INCREASE. 
Section 1302(c)(4) of the Patient Protection and Af-
fordable Care Act is amended— 
(1) by striking ‘‘For purposes of’’ and inserting 
the following: 
‘‘(A) IN GENERAL.—For purposes of’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) FREEZE IN PREMIUM ADJUSTMENT 
PERCENTAGE
INCREASE.—For plan years be-
ginning on or after January 1, 2027, the max-
imum annual limitation on cost sharing (as de-
scribed in section 156.130(a)(2) of title 45, 
Code of Federal Regulations) is equal to the 
greater of— 
‘‘(i) the maximum annual limitation 
on cost sharing for plan year 2025, as de-
scribed in the final rule published on April 
15, 2024 (89 Fed. Reg. 26218 et seq.); 
and 
‘‘(ii) 90 percent of the amount de-
scribed in clause (i), increased by the per-
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00414
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
415 
centage by which the average per capita 
premium for health insurance coverage in 
the United States for the preceding cal-
endar year (as estimated by the Secretary 
not later than October 1 of such preceding 
calendar year) exceeds such average per 
capita premium for 2024.’’. 
SEC. 50004. REQUIRING COVERAGE OF CERTAIN IMMUNIZA-
TIONS RECOMMENDED BY THE ADVISORY 
COMMITTEE ON IMMUNIZATION PRACTICES. 
(a) GROUP HEALTH PLANS AND HEALTH INSUR-
ANCE COVERAGE.— 
(1) PHSA.— 
(A) IN GENERAL.—Part D of title XXVII 
of the Public Health Service Act (42 U.S.C. 
300gg–111 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 2799A–11. COVERAGE OF CERTAIN IMMUNIZATIONS 
RECOMMENDED BY THE ADVISORY COM-
MITTEE ON IMMUNIZATION PRACTICES. 
‘‘(a) IN GENERAL.—With respect to plan years occur-
ring during the date of the enactment of this section, or 
beginning on or after the date of the enactment of this 
section and before January 1, 2030, a group health plan 
and a health insurance issuer offering group or individual 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00415
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
416 
health insurance coverage shall provide coverage for and 
shall not impose any cost sharing requirements for immu-
nizations that had in effect a recommendation from the 
Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention with respect 
to the individual involved as of October 25, 2024, includ-
ing such an immunization as updated or changed after 
that date under a supplement to a biologics license appli-
cation approved by the Food and Drug Administration. 
‘‘(b) SPECIAL RULE.—Subsection (a) shall not apply 
in the case of an immunization administered during the 
minimum interval established under section 2713(b) with 
respect to such immunization.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1302(e)(1)(B)(i) of the Patient Protection and 
Affordable 
Care 
Act 
(42 
U.S.C. 
18022(e)(1)(B)(i)) is amended by striking ‘‘sec-
tion 2713’’ and inserting ‘‘sections 2713 and 
2799A–11 of the Public Health Service Act’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following new section: 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00416
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
417 
‘‘SEC. 726. COVERAGE OF CERTAIN IMMUNIZATIONS REC-
OMMENDED BY THE ADVISORY COMMITTEE 
ON IMMUNIZATION PRACTICES. 
‘‘(a) IN GENERAL.—With respect to plan years occur-
ring during the date of the enactment of this section, or 
beginning on or after the date of the enactment of this 
section and before January 1, 2030, a group health plan 
and a health insurance issuer offering group health insur-
ance coverage shall provide coverage for and shall not im-
pose any cost sharing requirements for immunizations 
that had in effect a recommendation from the Advisory 
Committee on Immunization Practices of the Centers for 
Disease Control and Prevention with respect to the indi-
vidual involved as of October 25, 2024, including such an 
immunization as updated or changed after that date under 
a supplement to a biologics license application approved 
by the Food and Drug Administration. 
‘‘(b) SPECIAL RULE.—Subsection (a) shall not apply 
in the case of an immunization administered during the 
minimum interval established under section 2713(b) of the 
Public Health Service Act with respect to such immuniza-
tion.’’. 
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 
1001 note) is amended by inserting after the 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00417
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
418 
item relating to section 725 the following new 
item: 
‘‘Sec. 726. Coverage of certain immunizations recommended by the Advisory 
Committee on Immunization Practices.’’. 
(3) IRC.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9826. COVERAGE OF CERTAIN IMMUNIZATIONS REC-
OMMENDED BY THE ADVISORY COMMITTEE 
ON IMMUNIZATION PRACTICES. 
‘‘(a) IN GENERAL.—With respect to plan years occur-
ring during the date of the enactment of this section, or 
beginning on or after the date of the enactment of this 
section and before January 1, 2030, a group health plan 
shall provide coverage for and shall not impose any cost 
sharing requirements for immunizations that had in effect 
a recommendation from the Advisory Committee on Im-
munization Practices of the Centers for Disease Control 
and Prevention with respect to the individual involved as 
of October 25, 2024, including such an immunization as 
updated or changed after that date under a supplement 
to a biologics license application approved by the Food and 
Drug Administration. 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00418
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
419 
‘‘(b) SPECIAL RULE.—Subsection (a) shall not apply 
in the case of an immunization administered during the 
minimum interval established under section 2713(b) of the 
Public Health Service Act with respect to such immuniza-
tion.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘Sec. 9826. Coverage of certain immunizations recommended by the Advisory 
Committee on Immunization Practices.’’. 
(b) MEDICARE.—Section 1860D–2(b)(8)(B) of the 
Social Security Act (42 U.S.C. 1395w–102(b)(8)(B)) is 
amended— 
(1) by striking ‘‘with recommendations’’ and in-
serting ‘‘with— 
‘‘(i) recommendations’’; 
(2) by striking the period at the end and insert-
ing ‘‘; or’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(ii) for plan years occurring during 
the date of the enactment of this clause, or 
beginning on or after the date of the enact-
ment of this clause and before January 1, 
2030, in the case of a vaccine with respect 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00419
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
420 
to which such a recommendation is revoked 
with respect to the individual involved on 
or after October 25, 2024, including such 
a vaccine as updated or changed after that 
date under a supplement to a biologics li-
cense application approved by the Food 
and Drug Administration, the most recent 
recommendation that was in effect with re-
spect to such vaccine and such individual 
prior to such revocation.’’. 
(c) MEDICAID.— 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)(13)(B)— 
(i) by striking ‘‘individual, approved’’ 
and inserting ‘‘individual— 
‘‘(i) approved’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) for the period beginning on the 
date of the enactment of this clause and 
ending on December 31, 2029, approved 
vaccines, and the administration of such 
vaccines, that were recommended by such 
advisory committee with respect to the in-
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00420
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
421 
dividual involved as of October 25, 2024, 
including such a vaccine as updated or 
changed after that date under a supple-
ment to a biologics license application ap-
proved by the Food and Drug Administra-
tion.’’; and 
(B) in subsection (r)(1)(B)(iii), by— 
(i) striking ‘‘section 1928(c)(2)(B)(i)’’ 
and 
inserting 
‘‘clause 
(i) 
of 
section 
1928(c)(2)(B)’’; and 
(ii) inserting ‘‘, subject to the limita-
tion described in clause (iii) of such sec-
tion’’ after ‘‘pediatric vaccines’’. 
(2) COVERAGE FOR PREGNANT INDIVIDUALS.— 
Section 1902(a)(10) of the Social Security Act (42 
U.S.C. 1396a(a)(10)) is amended in the matter fol-
lowing subparagraph (G) by inserting ‘‘medical as-
sistance 
for 
vaccines 
described 
in 
section 
1905(a)(13)(B) and the administration of such vac-
cines,’’ after ‘‘complicate pregnancy,’’. 
(3) PROGRAM FOR DISTRIBUTION OF PEDIATRIC 
VACCINES.—Section 1928 of the Social Security Act 
(42 U.S.C. 1396s) is amended— 
(A) in subsection (c)(2)(B)— 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00421
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
422 
(i) in clause (i), by striking ‘‘clause 
(ii)’’ and inserting ‘‘clauses (ii) and (iii)’’; 
and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) For the period beginning on the date 
of the enactment of this clause and ending on 
December 31, 2029, the provider will not take 
into account any change in the schedule de-
scribed in clause (i) that removes the rec-
ommendation to administer a pediatric vaccine 
with respect to the vaccine-eligible child in-
volved if such pediatric vaccine was rec-
ommended with respect to such child under 
such schedule as of October 25, 2024, including 
with respect to such pediatric vaccine as up-
dated or changed after that date under a sup-
plement to a biologics license application ap-
proved by the Food and Drug Administration.’’; 
and 
(B) in subsection (e), by inserting ‘‘For 
purposes of the preceding sentence, during the 
period beginning on the date of the enactment 
of this sentence and ending on December 31, 
2029, the Secretary may not take into account 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00422
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
423 
any revision of such list that occurs on or after 
October 25, 2024, that removes a pediatric vac-
cine from such list if such vaccine was included 
in such list as of such date, including with re-
spect to such vaccine as updated or changed 
after that date under a supplement to a bio-
logics license application approved by the Food 
and Drug Administration.’’ after the period at 
the end. 
(4) STATE
FLEXIBILITY
IN
BENEFIT
PACK-
AGES.—Section 1937(b) of the Social Security Act 
(42 U.S.C. 1396u–7(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(9) COVERAGE
OF
ADULT
VACCINES.—Not-
withstanding the previous provisions of this section, 
a State may not provide for medical assistance 
through enrollment of an individual with benchmark 
coverage or benchmark-equivalent coverage under 
this section unless such coverage includes (and does 
not impose any deduction, cost sharing, or similar 
charge for) the medical assistance described in sec-
tion 1905(a)(13)(B).’’. 
(d) CHIP.—Section 2103 of the Social Security Act 
(42 U.S.C. 1397cc) is amended— 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00423
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
424 
(1) in subsection (c), by adding at the end the 
following new paragraph: 
‘‘(13) REQUIRED COVERAGE OF CERTAIN VAC-
CINES
RECOMMENDED
BY
THE
ADVISORY
COM-
MITTEE ON IMMUNIZATION PRACTICES.—Regardless 
of the type of coverage elected by a State under sub-
section (a), the child health assistance provided for 
a targeted low-income child shall include coverage, 
during the period beginning on the date of the en-
actment of this paragraph and ending on December 
31, 2029, of vaccines, and the administration of 
such vaccines, that had in effect a recommendation 
from the Advisory Committee on Immunization 
Practices of the Centers for Disease Control and 
Prevention with respect to the child involved as of 
October 25, 2024, including such a vaccine as up-
dated or changed after that date under a supplement 
to a biologics license application approved by the 
Food and Drug Administration.’’; and 
(2) in subsection (e)(2), by inserting ‘‘vaccines 
described in subsection (c)(13) administered during 
the period beginning on the date of the enactment 
of such subsection and ending on December 31, 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00424
Fmt 6652
Sfmt 6201
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS
425 
2029 (and the administration of such vaccines),’’ be-
fore ‘‘services described in section 1916(a)(2)(G)’’. 
Æ 
VerDate Sep 11 2014 
21:44 Feb 02, 2026
Jkt 069200
PO 00000
Frm 00425
Fmt 6652
Sfmt 6301
E:\BILLS\H6900.IH
H6900
ssavage on LAPJG3WLY3PROD with BILLS