I 
114TH CONGRESS 
2D SESSION 
H. R. 4989 
To amend title XIX of the Social Security Act to require States to provide 
cranial prostheses under the Medicaid program when a physician finds 
such treatment necessary for individuals affected by diseases and medical 
conditions that cause hair loss. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 18, 2016 
Ms. ROS-LEHTINEN (for herself, Ms. ESHOO, Mr. LOBIONDO, Mr. HUFFMAN, 
Ms. SPEIER, and Mr. ELLISON) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to require 
States to provide cranial prostheses under the Medicaid 
program when a physician finds such treatment nec-
essary for individuals affected by diseases and medical 
conditions that cause hair loss. 
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 ‘‘Cranial Prosthetic 
Medicaid Coverage Enhancement Act’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
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(1) Individuals chronically affected by hair loss 
due to diseases, such as the autoimmune skin condi-
tion alopecia areata, as well as individuals affected 
by acute hair loss due to chemotherapy or medical 
intervention face significant biological, social, and 
psychological health challenges. 
(2) Dermatologists, oncologists, and other 
qualified medical professionals consider cranial pros-
thetics to be a medically necessary option when 
treating individuals suffering from chronic, acute, or 
cyclical hair loss caused by a medical condition. 
(3) The cost of a cranial prosthetic can rep-
resent a significant financial burden for Medicaid 
program beneficiaries and coverage benefits across 
States are currently inconsistent and, in many cases, 
nonexistent. 
(4) While children participating in the Medicaid 
program are often significantly impacted by the ad-
ditional health effects caused by medical condition- 
related hair loss, inequitable and inconsistent cov-
erage benefits for cranial prosthetics means they can 
face serious difficulty accessing treatment, even with 
the assistance of a healthcare professional. 
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SEC. 3. IMPROVEMENT OF CRANIAL PROSTHESES COV-
ERAGE UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a)(10) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)) is amended— 
(1) in subparagraph (F), at the end by striking 
‘‘and’’; 
(2) in subparagraph (G), at the end by adding 
‘‘and’’; and 
(3) by inserting after subparagraph (G) the fol-
lowing new subparagraph: 
‘‘(H) that if medical assistance is included 
for inpatient hospital services for an individual, 
then the plan must include making medical as-
sistance available to the individual for biennial 
coverage of one cranial prosthesis with a benefit 
up to $400 if the dermatologist, oncologist, or 
attending physician of the individual certifies in 
writing the medical necessity of that proposed 
course of rehabilitative treatment;’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to items and serv-
ices furnished on or after January 1, 2017, without regard 
to whether or not final regulations to carry out such 
amendments have been promulgated by such date. 
Æ 
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