H.R. 6408 — ANCHOR Act of 2025

This section establishes a state option to provide Medicaid medical assistance under an existing optional eligibility group to specified uninsured individuals (as defined in new subsection (uu)) who have incomes not exceeding 100% of the federal poverty level (as defined in section 2110(c)(5) of the Social Security Act) and a qualifying condition. Qualifying conditions include serious mental illness, serious emotional disturbance, opioid use disorder, or stimulant use disorder (including with respect to cocaine or methamphetamine), as determined by a health care provider or certain state-approved entities (e.g., certified community behavioral health clinics, institutions for mental diseases, or state judicial, law enforcement, or child welfare agencies). Coverage must be provided in the same scope as for mandatory categorically needy individuals under subsection (a)(10)(A)(i), for an initial continuous one-year period with optional state extensions for subsequent one-year periods upon redetermination of eligibility. As a condition of the option, states must ensure development of a care plan within 60 days of enrollment by a qualified provider (e.g., physician, certified community behavioral health clinic) and report applicable behavioral health measures from the Core Set of Adult Health Care Quality Measures for Medicaid. (Thus, this optional coverage enables states to provide full-scope Medicaid benefits to targeted low-income individuals with behavioral health needs who lack other insurance.)