McGovern Introduces Legislation Easing Access to Medically Necessary Formulas

  • Fruits & Veggies

WASHINGTON, D.C.— Representatives James P. McGovern (D-MA), Ranking Member of the House Rules Committee and Co-chair of the Cystic Fibrosis Caucus, and John Rutherford (R-FL), Co-chair of the Crohn’s and Colitis caucus, led their colleagues in introducing legislation to remove barriers to access for all Americans who require medically necessary foods to lead healthy lives.

The Medical Nutrition Equity Act would require coverage of specialized formulas, vitamins, individual amino acids, or other medically necessary foods under Medicaid, the Children’s Health Insurance Program, Medicare, the Federal Employee Health Benefit Program, and private insurance for patients with specific gastrointestinal and inherited metabolic diseases and disorders.  It is narrowly drafted to focus on individuals for whom medically necessary nutrition is the treatment for their diseases.

“I’ve heard devastating stories from constituents struggling to access medically necessary foods to keep themselves or their child healthy,” said Congressman McGovern. “As a dad and husband, I can’t imagine not being able to access the food your child or your partner depends on to live. To me this is simple: no one should struggle getting medically necessary food, and insurance companies shouldn’t be creating more barriers to receiving proper care. Our bill cuts through the red tape and ensures those with inherited metabolic diseases or gastrointestinal conditions can access the nutrition they need.”

“Our health systems must be structured to support innovative treatments,” said Congressman Rutherford. “As co-chair of the Crohn’s and Colitis Caucus, where I advocate for those living with digestive diseases, I am excited to join Rep. McGovern to introduce this important legislation that would make medically necessary nutrition more easily accessible to patients across our nation.”

Approximately 2,000 infants every year are diagnosed with an inherited metabolic disorder. When left untreated, inherited metabolic diseases or gastrointestinal conditions can cause the body to fail to absorb necessary nutrients and food can even become toxic. An inability to access specialty formulas forces patients to go without adequate nutrition or seek hospitalization to maintain nutrition levels. Already, 40 states require coverage of medically necessary nutrition, but coverage is highly variable from state-to-state and does not apply to patients covered by private sector health plans governed by the Employee Retirement Income Security Act.

This bill builds on the precedent of the 2016 National Defense Authorization Act which improved coverage for medical nutrition for military families enrolled in TRICARE, so more Americans can access medically necessary nutrition.