Genomic Answers for Children’s Health Act of 2026

This bill amends the Medicaid program to clarify that whole genome and whole exome sequencing for children with certain medical needs is a covered service. It requires separate payment for these tests and directs the Secretary of Health and Human Services to conduct outreach and report on implementation, while the Comptroller General must assess access and make recommendations.

Sec. 2, Clarifying coverage for children: The bill adds whole genome and whole exome sequencing to the list of covered Medicaid services for children suspected of having a genetic disorder, rare disease, or health condition of unknown origin, including congenital anomalies, developmental delay, or intellectual disability. The sequencing must be ordered by a physician or other authorized provider as a first-tier test, and it includes analysis, interpretation, and data reporting. The bill also requires that payment for these tests be made separately and not bundled with other medical assistance.

Outreach and education: The Secretary of Health and Human Services must convene national organizations, states, hospitals, and others to identify implementation challenges and best practices to minimize claim denials. The Secretary must also conduct outreach to ensure awareness of early and periodic screening benefits and publish a public report within two years on payment amounts, number of children receiving sequencing, health outcomes, and types of services provided.

Report: Within two years, the Comptroller General must collect feedback from stakeholders on access to sequencing, changes in care, remaining challenges, and health professional awareness. The report must assess impacts of prior authorization, workforce and reimbursement issues for genetic counselors, and alignment of market costs with the Medicare clinical laboratory fee schedule. Recommendations for additional guidance or improvements must be made to the Secretary.

Effective date: The amendments apply beginning January 1, 2027.