H.R. 7145: Essential Health System Definition Act

Summary

This bill, introduced in the House of Representatives on January 16, 2026, seeks to amend Title XIX of the Social Security Act to establish a statutory definition of an "essential health system." The main purpose of the legislation is to provide a clear, consistent standard for what constitutes an essential health system eligible for certain federal funding and programs.

Key Provisions

The bill would:

1. Define an "essential health system" as a health care delivery system that:

   • Provides a comprehensive range of inpatient and outpatient services
   • Serves as a safety net provider for Medicaid, uninsured, and underinsured patients in a given geographic area
   • Participates in graduate medical education programs to train new healthcare providers

2. Require the Secretary of Health and Human Services to:

   • Establish criteria for designating health systems as "essential"
   • Maintain a list of federally-recognized essential health systems
   • Provide enhanced Medicaid reimbursement rates for services delivered by essential health systems

3. Allow essential health systems to be eligible for additional federal grants and program participation, such as:

   • Increased funding for infrastructure improvements and technology upgrades
   • Participation in innovative payment and delivery system reform models

Impact and Significance

This bill aims to formalize the definition of an "essential health system" in federal law. By establishing clear criteria, it could provide more stability and predictability for health systems that serve as critical access points for Medicaid and uninsured patients.

The enhanced Medicaid reimbursement rates and eligibility for additional federal programs and funding could help strengthen the financial viability of these essential health systems. This could, in turn, improve access to comprehensive healthcare services in underserved communities across the country.

Procedural Aspects

The bill was introduced in the House of Representatives on January 16, 2026 and has been referred to the House Committee on Energy and Commerce for further consideration. No additional legislative actions have been reported at this time.