Federal health programs would cover medical formulas for rare digestive and metabolic disorders

What does this do?

S 3304 requires Medicare, Medicaid, CHIP, and federal employee health plans to cover special medical foods, formulas, vitamins, amino acids, and related equipment for people with qualifying digestive and inherited metabolic disorders. Covered conditions include rare genetic disorders found through newborn screening, short bowel syndrome, severe food allergies, Crohn's disease, eosinophilic esophagitis, and certain liver and pancreatic diseases. Everyday diet foods, general gluten-free products, and diabetes management foods are excluded from coverage.

Who does it affect?

The bill directly affects children and adults with rare metabolic disorders, serious gastrointestinal diseases, or severe food-protein allergies who rely on specialized formulas as their primary nutrition source, along with their families. Federal employees covered through the federal health benefits program also gain coverage, while private insurers are not legally required to comply.

Why does it matter?

Coverage for these specialized products is currently inconsistent, and many patients pay out of pocket or go without them. Any state laws providing stronger coverage protections remain in effect and are not overridden by this bill.

What does it cost, and who pays?

• Medicare pays 80% after fee schedule set
• Families currently bear high out-of-pocket costs
• Private insurers not legally required to cover