States gain option to cover uninsured people with mental illness, substance use disorders
S. 3300 — ANCHOR Act of 2025 · Filed by Marsha Blackburn (R-TN) · Introduced Dec 2, 2025 · Referred to committee
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What it does
This bill creates a new optional Medicaid category 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. Eligible individuals receive full Medicaid coverage for an initial 12-month period, renewable annually at state discretion, provided they have a care plan developed within 60 days of enrollment and states report on behavioral health quality measures.
Why we flagged it
The bill's sole operative mechanism is to add a new optional Medicaid eligibility category for states. It does not mandate coverage, does not appropriate funds, and does not alter existing Medicaid rules for other populations—it simply creates a state option to cover a previously ineligible group.
What the text implies
- Expansion is entirely optional for states; uptake will vary by state fiscal capacity and political will, creating potential disparities in access to treatment across state lines.
- Care plan requirement (60-day window) may create administrative burden on providers and states, potentially delaying enrollment or creating bottlenecks in behavioral health systems.
The full analysis lists 4 implications of this text.
Who stands to gain
Behavioral health providers (community mental health centers, certified community behavioral health; Emergency departments and hospitals (expanded Medicaid coverage may reduce uncompensated care); Primary care and clinical practices (expanded patient base with insurance coverage)