Medicare Advantage must now cover safety-net providers serving the poor
S. 2793 — Ensuring Access to Essential Providers Act of 2025 · Filed by Bill Cassidy (R-LA) · 1 cosponsor · Introduced Sep 11, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage (MA) plans to include essential community providers—such as federally qualified health centers, safety-net hospitals, mental health clinics, and providers serving low-income and rural populations—in their networks and to contract with them. Plans must ensure adequate geographic distribution and access for vulnerable populations; if they cannot meet the standard, they must justify why to the Secretary, who can deny plan approval if the justification is insufficient. MA plans must also pay these providers at rates consistent with Medicare rules.
Why we flagged it
The bill's core mechanism is a regulatory mandate requiring MA plans to include and contract with safety-net providers, with Secretary enforcement via plan approval denial. It is a consumer-protection / network-adequacy rule, not a subsidy or deregulation.
What the text implies
- MA insurers may respond by narrowing non-essential-provider networks or raising premiums to offset mandatory contracting costs, potentially shifting costs to all MA enrollees.
- The Secretary's discretion to define 'sufficient number and geographic distribution' and to approve/deny plans based on justification creates regulatory uncertainty and may lead to litigation over network adequacy standards.
The full analysis lists 4 implications of this text.
Who stands to gain
Federally qualified health centers (FQHCs); Safety-net hospitals and disproportionate-share hospitals (DSH); Rural hospitals and critical access hospitals