States get option to cover uninsured people with serious mental illness
H.R. 6408 — ANCHOR Act of 2025 · Filed by August Pfluger (R-TX) · Introduced Dec 3, 2025 · Referred to committee
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What it does
This bill creates a new optional Medicaid pathway for states to cover uninsured individuals earning up to 100% of the federal poverty line who have been diagnosed with serious mental illness, serious emotional disturbance, opioid use disorder, or stimulant use disorder. States choosing to participate must ensure enrollees receive a care plan within 60 days and report quality metrics; coverage lasts one year initially with optional annual renewals.
Why we flagged it
The bill's core mechanism is a voluntary state option to extend Medicaid coverage to a specific, clinically defined population (uninsured individuals with serious mental illness or substance use disorders). It is a public health measure, not a tax provision, deregulation, or private carve-out.
What the text implies
- States retain discretion to opt in or out, creating potential coverage gaps and interstate disparities in access to behavioral health services for the poorest uninsured individuals.
- The 100% poverty-line income cap is restrictive; many individuals with serious mental illness or substance use disorder earn slightly above this threshold and would remain uninsured.
The full analysis lists 4 implications of this text.
Who stands to gain
pharmaceutical manufacturers (antipsychotics, opioid-use-disorder medications, stimulant-use-disorde; behavioral health service providers and clinics; community mental health centers and certified community behavioral health clinics