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HR 7118

Genomic Answers for Children’s Health Act of 2026

119th Congress Introduced by Jake Auchincloss and 16 co-sponsors

Medicaid would cover whole genome or exome sequencing for qualifying children, with separate, explicit payment and coordinated efforts to reduce access barriers.

Introduced in House
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Bill Summary · HR 7118

Genomic Answers for Children’s Health Act of 2026 (H.R. 7118, 119th Congress)

Overview
- Purpose: Amends title XIX (Medicaid) to explicitly cover whole genome sequencing (WGS) and whole exome sequencing (WES) for children with certain medical needs, clarifying payment separate from other medical services and promoting outreach, education, and evaluation of implementation.
- Short title: Genomic Answers for Children's Health Act of 2026
- Introduced: January 15, 2026; Sponsors include Rep. Peters and a broad group of co-sponsors.

Key Provisions

1) Medicaid coverage clarification for WGS/WES (Section 2(a) and 2(kk))
- Adds new Medicaid-covered service:
- Whole genome sequencing and whole exome sequencing (as defined in the bill) when ordered by a physician or qualified provider within their scope of practice under state law.
- Use case: first-tier test for individuals suspected to have a genetic disorder, rare disease, or unknown-origin health condition, including congenital anomalies, global developmental delay, or intellectual disability.
- Coverage applies in both inpatient and outpatient settings.
- Definition of WGS/WES (Section 2(kk)):
- WGS/WES includes sequencing of the entire genome or exome and any analysis, interpretation, and data report derived from such sequencing.
- May involve sequencing of a first-degree biological relative if it is for determining potentially disease-causing variants in the patient or the relative.

2) Payment structure (Section 2(b))
- Requires that payment for WGS/WES is made separately and is not bundled with payment for any other medical assistance under the State plan.
- This aims to prevent cross-subsidization and ensure explicit reimbursement for these tests.

3) Outreach, education, and implementation support (Section 2(c))
- Secretary of Health and Human Services must:
- Convene national organizations and stakeholders (pediatricians, pediatric rare disease specialists, children's hospitals, geneticists, genetic counselors, test developers, Medicaid entities) to identify challenges and best practices to minimize claim denials due to prior authorization or administrative requirements.
- Conduct outreach to ensure awareness of the early and periodic screening, diagnostic, and treatment services (ESD/T) benefit under Medicaid and to promote access to necessary screenings and treatments.
- Publish a report within 2 years of enactment detailing:
- Payment amounts for WGS/WES under each state plan.
- Number of children receiving sequencing via Medicaid, health outcomes, types of services provided, and other relevant information.

4) Government oversight and assessment (Section 2(d))
- Comptroller General (GAO) must, within 2 years, collect and analyze feedback from organizations and entities described in (b) outreach plus other stakeholders on:
- Access experiences, barriers, and denials.
- Changes to care following sequencing.
- Remaining challenges for Medicaid-eligible children receiving ES/ESD/T services.
- Health professional awareness of the amendments.
- Assess impacts on access to sequencing, including:
- Prior authorization delays and payment uncertainties.
- Workforce and reimbursement challenges for genetic counselors.
- Alignment of market costs with the Medicare clinical laboratory fee schedule and how adjustments could affect affordability.
- GAO to make recommendations to HHS Secretary for improvements.

5) Effective date (Section 2(e))
- The amendments take effect beginning January 1, 2027.

Impact and Beneficiaries

  • Primary Beneficiaries:
    • Medicaid-eligible children who may need WGS/WES to diagnose or guide treatment for genetic disorders, rare diseases, or conditions of unknown origin.
    • Families seeking clarity on diagnostic possibilities and access to targeted treatments or clinical management plans.
  • Stakeholders affected:
    • State Medicaid programs (planning and reimbursement for WGS/WES).
    • Pediatricians, geneticists, laboratories, and genetic counselors (through coverage decisions, prior authorizations, and reimbursement).
    • Hospitals and health systems serving children with complex or undiagnosed conditions.
  • Systemic effects:
    • Potentially increased upfront costs due to sequencing but with clarified reimbursement separate from other services.
    • Need for coordination among providers, payers, and testing laboratories to streamline authorization and reduce denials.

Procedural and Timeline Considerations

  • House passage and Senate action required for enactment.
  • Once enacted, provisions apply starting January 1, 2027.
  • Ongoing oversight:
    • Outreach and education efforts by HHS Secretary.
    • GAO evaluation and reporting within two years of enactment, with ongoing data collection and recommendations.

Notes
- The bill places emphasis on access, transparency in payment, and stakeholder coordination to minimize barriers to sequencing under Medicaid.
- No specific dollar amounts for sequencing payment are defined in the text; the required reports will detail payment amounts by state.

Compiled from official sources — confirm details with the bill’s official record.

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