John Lewis Equality in Medicare and Medicaid Treatment Act of 2026
- Sponsor
- Sen. Booker, Cory A. [D-NJ]
- Committees
- Finance Committee (primary)
- Last action
- Sep 30, 2026
Bottom line
The bill mandates CMMI to integrate health equity and social determinants of health into its core mission and model development, including a new dedicated payment model, to improve care access and reduce disparities for Medicare and Medicaid beneficiaries.
What it actually does
This bill amends Section 1115A of the Social Security Act to explicitly mandate that the Center for Medicare and Medicaid Innovation (CMMI) prioritize health equity, address health disparities, and consider social determinants of health when developing, selecting, and expanding new payment and service delivery models. It specifically requires CMMI to establish and begin testing a 'social determinants of health payment model' by December 31, 2027, targeting behavioral health services, underserved areas, and Medicaid-eligible pregnant and postpartum women.
Proponents argue
Supporters argue this bill is crucial for addressing long-standing health inequities and disparities in the Medicare and Medicaid programs by explicitly integrating health equity considerations into CMMI's core mission and model design. They contend it will lead to better health outcomes for underserved populations and potentially reduce overall healthcare costs by tackling the root causes of poor health.
Opponents contend
Critics might argue that mandating specific focus areas and a new payment model could overly constrain CMMI's flexibility and innovation, potentially diverting resources from other promising models or increasing administrative burden. Some might also express concern about the potential for increased costs associated with new models, especially those addressing social determinants, without clear pathways for cost savings.
The bill is short and relatively straightforward, making it accessible for a quick read and understanding of its core intent.
Section 2(1)(A), amending Section 1115A(a)(1)
Explicitly Including Health Equity in CMMI's Purpose
This provision adds "advance health equity" to the stated purpose of the Center for Medicare and Medicaid Innovation (CMMI). This means CMMI's core mission, as defined in law, will now explicitly include working towards reducing health disparities and ensuring fair access to healthcare for all beneficiaries.
Supporters argue
Supporters argue this is a foundational change, ensuring that CMMI's innovative models are not only about cost savings and quality but also actively work to close equity gaps, which is essential for a just healthcare system.
Critics contend
No specific opposition is typically raised against explicitly including health equity in a mission statement, though some might argue it's an unnecessary addition if CMMI is already implicitly considering these factors.
Tradeoffs
The tension might be between focusing on broad cost savings/quality improvement versus targeted equity initiatives, though proponents argue these goals are complementary.
Section 2(1)(B), amending Section 1115A(a)(3)
Broadening Expertise for CMMI Model Design
This provision requires CMMI to consult with specific offices within HHS, including the Office of Minority Health, Office of Rural Health Policy, and Office on Women's Health. It also mandates the inclusion of experts with knowledge of "the causes of health disparities and the social determinants of health" when designing models, ensuring a wider range of perspectives informs model development.
Section 2(2)(A)(i)(II), amending Section 1115A(b)(2)(A)
Mandating Health Equity and Access Considerations in Model Selection
For models beginning on or after January 1, 2027, CMMI must ensure they "address health equity as well as improving access to care received by individuals receiving benefits." This makes health equity a mandatory criterion for selecting new models, alongside improving access, ensuring that future innovations actively work to close equity gaps.
Section 2(2)(A)(i)(III) and Section 2(5), amending Section 1115A(b)(2)(A) and adding new subsection (h)
Establishment of a Social Determinants of Health Payment Model
This is a key provision requiring CMMI to establish and begin testing a "social determinants of health payment model" by December 31, 2027. This model will test innovations in payment and service delivery focusing on behavioral health, conditions/comorbidities in underserved areas for Medicare/Medicaid beneficiaries, and Medicaid-eligible pregnant and postpartum women.
Section 2(2)(A)(ii), amending Section 1115A(b)(2)(C)
Adding Health Disparity and Access Impact to Model Evaluation
This provision adds two new criteria for CMMI to consider when selecting models: whether the model will affect access to care for high-risk patients or those in underserved areas, and whether it has the potential to reduce health disparities (including minority and rural disparities). These criteria will guide CMMI's choices for future models.
Section 2(3), amending Section 1115A(c)
Considering Health Equity for Model Expansion
This provision amends the criteria for expanding CMMI models. It states that a model cannot be expanded if it would "increase health inequities" and that a model can be expanded if it would "improve health equity." This explicitly links health equity to the decision of whether to scale up successful models.
Section 2(4), amending Section 1115A(g)
Enhanced Reporting on Health Equity and Social Determinants
This provision mandates that CMMI's reports to Congress, submitted after the bill's enactment, must include specific information. This includes details on interventions addressing social determinants of health, health disparities, or health equity in payment models; estimated federal savings from reducing disparities; and the effectiveness of interventions in mitigating negative health outcomes and costs associated with social determinants.