Massachusetts House Bill H1165

Massachusetts 2025-2026 Regular Session

• Introduced: 2/27/25
• Refer: 2/27/25

Caption

Providing for certain health insurance coverage

Impact

The proposed changes in H1165 could significantly impact health insurance policies across the Commonwealth by standardizing the coverage for enteral formulas. If enacted, the bill would require both individual and group health insurance plans to cover these medically necessary treatments. The legislation specifies that such coverage should not be limited to merely general nutritional supplements, but rather focus on medically necessary treatments for specific diseases such as Crohn's Disease, eosinophilic gastrointestinal disorders, and severe food allergies, among others.

Summary

House Bill H1165 aims to amend sections of Massachusetts General Laws to enhance health insurance coverage for enteral formulas used at home. The bill specifically targets coverage for enteral formulas, whether administered orally or through tube feeding, for individuals insured under the Group Insurance Commission. It stipulates that these formulas should be deemed medically necessary upon a physician's written order, establishing a framework for the treatment of certain medical conditions that lead to malnourishment or severe health consequences.

Contention

Debate surrounding H1165 may center on the definitions of medically necessary treatments and the potential implications for health insurance costs. Some stakeholders may argue that requiring coverage for enteral formulas could lead to increased premiums or changes in policy structures. Others may emphasize the need for such coverage to prevent severe health issues resulting from untreated conditions, advocating for the right of patients to access necessary medical treatments without financial burden. The dividing line may thus emerge between cost control measures and the imperative of securing adequate healthcare access for vulnerable populations.