Human services: medical services; coverage for prescribed pediatric extended care; require. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 109u. TIE BAR WITH: HB 5252'25

2025-2026 Regular Session Introduced by Joe Aragona and 37 co-sponsors

Requires Medicaid coverage for prescribed pediatric extended care under part 219A, expanding access for medically complex children; enactment depends on companion bills.

bill electronically reproduced 11/12/2025

#children:health #healthfacilities:other #humanservices:medicalservices

Summary — HB 5251 (103rd Legislature)

Title: Human services: medical services; coverage for prescribed pediatric extended care; require.
Primary sponsor: Rep. Curtis VanderWall.
Introduced: March 14, 2025; electronically reproduced November 12, 2025.
Status: Referred to House Committee on Health Policy (read first time 11/12/2025).
Statutory change: Adds section 109u to the Social Welfare Act, 1939 PA 280 (MCL 400.1–400.119b).
Tie-bar: The enactment is conditioned on enactment of Senate Bill No. ____ (request S00430'25) or House Bill No. 5252 (request H00430'25).

Purpose and intent

HB 5251 requires the Department (under the Social Welfare Act) to provide coverage under the state's Medical Assistance (Medicaid) program for "prescribed pediatric extended care" as defined in part 219A of the Public Health Code (1978 PA 368, MCL 333.21951–333.21971). The bill’s principal intent is to make pediatric extended care services an explicit Medicaid-covered benefit.

Key provisions

Adds a new section (109u) to the Social Welfare Act mandating Medicaid coverage for prescribed pediatric extended care under part 219A of the Public Health Code.

No implementing details (rates, eligibility criteria beyond existing part 219A definitions, or effective date) are included in the text; coverage would operate consistent with part 219A standards and existing Medicaid rules.

Contains a conditional enactment clause (tie-bar) — the provision does not take effect unless a companion bill (SB ____ or HB 5252) is also enacted.

What is affected / who is impacted

Medicaid program beneficiaries: Children who meet the criteria for prescribed pediatric extended care under part 219A would become eligible to receive those services through Medicaid.

Families and caregivers of medically complex children: Increased access to covered care and potentially reduced out‑of‑pocket costs.

Pediatric extended care providers and facilities: Potential increase in payer mix and Medicaid utilization; may require participation/compliance with Medicaid billing and quality standards.

State budget and federal matching funds: Expanding covered benefits generally affects state Medicaid expenditures and may draw federal Medicaid matching dollars (specific fiscal impact not provided in the bill text).

Procedural notes and related legislation

Referred to House Committee on Health Policy on 11/12/2025 after introduction and first reading.

Companion/related bills: SB 207 (companion) and HB 5252 are tied to the bill’s effective operation per the tie-bar.

Further committee hearings, fiscal analyses, and concurrence with the companion bill will shape timing and implementation.