Medical Foods and Formulas Access Act of 2025

Key Points

• This bill requires Medicare, Medicaid, CHIP, and the Federal Employee Health Benefits Program to cover 'medically necessary food'—special formulas, low-protein products, vitamins, and amino acids—for people with digestive and inherited metabolic disorders whose bodies cannot process normal food.
• Without these specialized foods, patients—especially children—face severe consequences including malnutrition, intellectual disability, repeated hospitalizations, and even death. About 2,000 babies per year are diagnosed with inherited metabolic disorders requiring this treatment.
• The bill eliminates the requirement that formula must be given through a feeding tube to qualify for insurance coverage, allowing patients who can drink formula orally to receive coverage too. This avoids unnecessary surgeries and reduces costs.
• Covered conditions include inherited metabolic disorders, inflammatory bowel disease (like Crohn's), severe food allergies, and malabsorption conditions like short bowel syndrome. The bill explicitly excludes weight-loss products, standard gluten-free foods, and foods marketed for diabetes.
• Coverage timelines are staggered: CHIP and federal employee plans must comply 1 year after enactment, Medicaid within 2 years, and Medicare within 3 years. Medicare will pay 80% of the cost under a fee schedule set by HHS.
• The bill encourages but does not require private insurers to also cover medical foods. It also preserves existing state laws that already provide broader coverage, so no state loses ground on protections they've already enacted.