An Act expanding the treatment of cleft palate and cleft lip

194th Legislature (2025-2026) Introduced by Steve Ultrino

Expands cleft lip/palate treatment coverage to individuals of any age, not just children under 18.

Hearing scheduled for 06/22/2026 from 10:30 AM-01:30 PM in A-1

Summary of Bill: H 5477 (194th Massachusetts General Court)

Purpose and Intent

The bill, titled “An Act expanding the treatment of cleft palate and cleft lip,” aims to broaden the individuals who are eligible for coverage and treatment cost-sharing related to cleft lip and cleft palate.

It shifts the scope from children under 18 to include “any individual,” thereby expanding access beyond minors to adults.

Key Provisions and Changes

The bill makes the following amendments across multiple statutory sections to redefinine who is responsible for coverage of cleft lip and cleft palate treatment:

Section 17J of Chapter 32A

Change: Replace the phrase “children under the age of 18” with “any individual.”
Effect: Removes age limitation for coverage determinations tied to this section.

Section 10G of Chapter 118E

Change: Replace “For children under the age of 18, the division” with “The division.”
Effect: Removes age-specific language for coverage decisions by the division.

Sections 47BB of Chapter 175; 8EE of Chapter 176A; 4EE of Chapter 176B; 4W of Chapter 176G; 12 of Chapter 176I

Change: Replace language stating “a child under the age of 18 shall cover the cost of treating cleft lip and cleft palate for the child” with “an individual shall cover the cost of treating cleft lip and cleft palate for the individual.”
Effect: Establishes that the coverage responsibility applies to individuals of any age, not just children.

Who Is Affected

Individuals who require treatment for cleft lip and/or cleft palate.

The changes remove the age-based limitation, potentially impacting:

Adults with cleft conditions seeking coverage for treatment.
Insurers and state programs administering these benefits, who would apply coverage and cost-sharing to individuals of any age.

Procedural and Timeline Details

The bill was filed on February 7, 2025 (House Docket No. 4385; H 5477).

Legislative history includes:

Referred to House Rules (March 24, 2025).
Subsequent actions: referred to Joint Rules, with rules suspended and referred to the committee on Financial Services (as of March 2025).
In the 2025–2026 session, the bill progressed to the Senate with actions noted.
The latest available action shows Senate concurrence as of June 4, 2026, indicating passage by the Senate.

Practical Impact

Expands eligibility for cleft lip/palate treatment coverage to all individuals, not just children.

Could affect premium calculations, copayments, and coverage determinations for adults with cleft-related needs.

Requires state agencies and/or insurers to apply uniform coverage rules across all ages for cleft lip/palate treatment.

Notable Details

The bill is a targeted amendment across multiple General Laws (Chapters 32A, 118E, 175, 176A, 176B, 176G, and 176I) to align coverage requirements with an all-ages standard.

The text maintains a consistent terminology shift from “child under 18” to “individual.”

If you’d like, I can prepare a side-by-side comparison of current law versus the proposed amendments, or a one-page briefing for stakeholders (patients, insurers, healthcare providers).