This bill makes sure that people with certain digestive and inherited metabolic disorders can get special medical foods covered by federal health insurance programs. These aren't regular foods—they're specially formulated products like nutritional formulas, amino acids, and vitamins that people with conditions like short bowel syndrome, cystic fibrosis, inherited metabolic disorders, and severe food allergies need to survive and stay healthy.

Right now, coverage for these medical foods is inconsistent across different insurance programs and states. Some insurance companies only cover them if patients use feeding tubes, even when people can drink the formula by mouth. This bill requires Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and federal employee health plans to cover medically necessary food and the equipment needed to give it. The bill also encourages private insurance companies to do the same. For Medicare, the government will pay 80 percent of the cost after the bill takes effect in three years.

The bill specifically covers medical foods for conditions like inflammatory bowel disease, food protein allergies, pancreatic disease, and dozens of inherited metabolic disorders that babies are screened for at birth. It protects patients' right to take formulas by mouth instead of through feeding tubes when possible, which reduces medical risks and costs. The bill also makes clear that states can't require feeding tubes unnecessarily and that coverage must include any vitamins or amino acids a doctor prescribes as part of treatment. This ensures that families dealing with these serious conditions won't face gaps in coverage that could lead to malnutrition, hospitalization, or worse.

Medical Foods and Formulas Access Act of 2025

McGovern, James P.

Medical Foods and Formulas Access Act of 2025This bill expands coverage under Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federal Employees Health Benefits Program to include medically necessary food and associated equipment and supplies.The bill defines medically necessary food as specially formulated and processed products (e.g., nutritional formulas) prescribed by health care practitioners for individuals who have special dietary requirements because of certain digestive or metabolic disorders or conditions.