Diabetes Foot Health Access and Modernization Act of 2026
- Sponsor
- Sen. Young, Todd [R-IN]
- Committees
- Finance Committee (primary)
- Last action
- Mar 12, 2026
Bottom line
This bill expands Medicaid coverage for podiatric services and clarifies Medicare access to therapeutic diabetic shoes, aiming to improve foot health for beneficiaries with diabetes and reduce administrative burdens.
What it actually does
This bill amends the Social Security Act to expand the definition of 'physician' under Medicaid to include Doctors of Podiatric Medicine (DPMs) for covered services, thereby ensuring Medicaid beneficiaries have access to podiatric care. It also clarifies and streamlines the documentation requirements for therapeutic diabetic shoes under Medicare, aiming to improve access to this preventative care for individuals with diabetes.
Proponents argue
Proponents argue this bill will significantly improve access to critical foot and ankle care for Medicaid beneficiaries, especially those with diabetes, by formally recognizing podiatric physicians more broadly. They also contend that clarifying Medicare documentation for diabetic shoes will reduce administrative hurdles and ensure timely access to essential preventative care, ultimately reducing severe diabetic complications like amputations and associated healthcare costs.
Opponents contend
Opponents might argue that expanding the definition of 'physician' under Medicaid could lead to increased program costs without sufficient evidence of improved outcomes or that existing coverage is adequate. Concerns could also be raised about potential for fraud or abuse if documentation requirements for diabetic shoes are perceived as too relaxed, though the bill aims to clarify rather than relax existing standards.
The bill is very concise and clearly written, allowing for a quick and comprehensive understanding of its provisions within a short timeframe.
Section 2(a), Section 1905(a)(5)(A) of the Social Security Act
Recognizing Doctors of Podiatric Medicine as Physicians Under Medicaid
This provision amends the Social Security Act to broaden the definition of 'physician' for Medicaid purposes. It specifically includes Doctors of Podiatric Medicine (DPMs) by referencing paragraphs (1) and (3) of section 1861(r) of the Act, which covers medical and osteopathic doctors and podiatrists for specific services. This change ensures that physician services delivered by podiatric physicians are covered under Medicaid, aligning their recognition more closely with Medicare's existing policy.
Supporters argue
Supporters argue this amendment is crucial for ensuring Medicaid beneficiaries receive comprehensive and timely foot and ankle care, which is vital for preventing serious complications, especially for individuals with diabetes. They contend it eliminates an outdated disparity between Medicaid and Medicare's recognition of DPMs, promoting better health outcomes and potentially reducing long-term costs.
Critics contend
Some might argue that this expansion could lead to increased Medicaid program costs, and that current, more restrictive coverage is sufficient. Concerns about potential overutilization of services or the need for additional oversight could also be raised, although proponents emphasize the preventative benefits.
Tradeoffs
The provision navigates the tension between expanding access to specialized medical care for a vulnerable population and managing potential increases in program expenditures. It also addresses the professional recognition and scope of practice for podiatric physicians within federal health programs.
Section 2(b)
Effective Date for Medicaid Podiatric Physician Recognition
The amendment recognizing podiatric physicians under Medicaid generally applies to services furnished on or after January 1, 2026. However, for states that require specific legislative changes to their state plans to comply with this new federal requirement, the effective date is extended. These states will have until the first day of the first calendar quarter beginning after the close of their first regular legislative session that starts after the bill's enactment to implement the changes.
Section 3(a), Section 1861(s)(12) of the Social Security Act
Clarifying Medicare Documentation Requirements for Therapeutic Diabetic Shoes
This provision amends Medicare's coverage criteria for extra-depth or custom-molded shoes with inserts for individuals with diabetes. It clarifies that a physician must document specific medical conditions, such as peripheral neuropathy, a history of foot ulcers, or foot deformity. The physician must also attest that the individual has a diabetes diagnosis, is under a comprehensive plan of care for their diabetic condition, and specifically needs such shoes. The shoes must then be properly fitted and furnished by a physician or another qualified individual, such as a pedorthist or orthotist.
Section 3(b), Section 1877(h)(6) of the Social Security Act
Conforming Amendment for Diabetic Shoe Coverage
This is a technical amendment to Section 1877(h)(6) of the Social Security Act, which outlines exceptions to the physician self-referral prohibitions (commonly known as the Stark Law). It adds 'Extra-depth shoes with inserts or custom molded shoes with inserts' to the list of items that are exempt from certain referral prohibitions. This ensures that physicians can refer patients for diabetic shoes without inadvertently violating self-referral laws, aligning with the expanded coverage of diabetic shoes.
Section 3(c)
Effective Date for Medicare Diabetic Shoe Documentation Changes
The amendments related to Medicare documentation requirements for therapeutic diabetic shoes will apply to items and services furnished on or after January 1, 2028. This sets a future date for the implementation of the clarified rules.
Amends Section 1905(a)(5)(A) of the Social Security Act by striking 'section 1861(r)(1)' and inserting 'paragraphs (1) and (3) of section 1861(r)'. This change specifically expands Medicaid's definition of 'physician' to include Doctors of Podiatric Medicine (DPMs) for services they are legally authorized to perform, aligning it with Medicare's broader recognition.
Section 2(a)
Why it matters:This is standard legislative practice for amending existing statutes, relying on precise legal references rather than re-stating lengthy definitions. It is not necessarily evasive but requires legal expertise to fully unpack the implications.
Case for: Supporters argue this precise amendment ensures legal consistency and avoids redundancy, leveraging existing statutory definitions for clarity and efficiency in legislative drafting. It streamlines the legislative process by building upon established legal frameworks.
Case against: Critics might argue that such reliance on complex cross-references makes the bill less accessible to the public and non-legal professionals, obscuring the full scope of the change without external research into the referenced statutes.
Estimated impact: Expands Medicaid coverage for podiatric services across all states, potentially impacting millions of beneficiaries and thousands of podiatric physicians by increasing access to specialized foot and ankle care.
Amends Section 1877(h)(6) of the Social Security Act by inserting '(M) Extra-depth shoes with inserts or custom molded shoes with inserts.' This adds therapeutic diabetic shoes to the list of items exempt from physician self-referral prohibitions (Stark Law).
Section 3(b)
Why it matters:This is standard legislative practice to ensure consistency across related statutes. It prevents unintended legal complications arising from the primary policy changes by aligning different parts of the Social Security Act.
Case for: Proponents argue this is essential to prevent unintended legal barriers for physicians referring patients for diabetic shoes, ensuring that the primary intent of improving access is not undermined by regulatory conflicts or compliance concerns.
Case against: No specific opposition is typically raised against such technical conforming amendments, as they are designed to ensure legal consistency and operational efficiency without introducing new policy debates.
Estimated impact: Ensures legal clarity for all physicians and suppliers involved in providing diabetic shoes under Medicare, preventing potential compliance issues and facilitating patient access to necessary footwear.