ANCHOR Act of 2025

Bill Summary: ANCHOR Act of 2025 (H.R. 6408)

Overview

The Access to New Community Health Opportunities and Recovery Act of 2025, known as the ANCHOR Act, is a legislative proposal to amend the Social Security Act. The primary purpose of the bill is to create a State option—meaning a voluntary choice for state governments—to provide Medicaid (medical assistance) to specific uninsured individuals struggling with serious mental illness or substance use disorders.

Key Provisions

Eligibility Criteria

To qualify as a "specified individual" under this bill, a person must meet three primary requirements:
1. Insurance Status: Must be uninsured.
2. Income Level: Income cannot exceed 100 percent of the federal poverty line for the size of their family.
3. Medical Condition: Must have a "qualifying condition" as determined by a healthcare provider or a state-approved entity.

Qualifying Conditions

The bill specifically defines qualifying conditions to include:
* Serious mental illness.
* Serious emotional disturbance.
* Opioid use disorder.
* Stimulant use disorder (explicitly including cocaine or methamphetamine).

Determination of Need

The bill allows a wide range of entities to certify that an individual has a qualifying condition, including:
* Healthcare providers.
* Emergency departments.
* Certified community behavioral health clinics.
* State-funded mental health/substance use service providers.
* Institutions for mental diseases.
* State judicial, law enforcement, or child welfare agencies.

Duration and Scope of Coverage

• Scope: Coverage is provided in the same manner and scope as standard medical assistance.
• Duration: Eligibility is granted for an initial 1-year period.
• Extensions: States may extend coverage for subsequent 1-year periods, provided the state redetermines that the individual still meets the eligibility criteria.

Quality and Accountability Measures

If a state chooses to exercise this option, it must adhere to two specific quality-of-care mandates:
1. Care Plans: A physician or qualified healthcare provider must develop a personalized care plan for the individual within 60 days of enrollment.
2. Reporting: The state must report behavioral health measures using the "Core Set of Adult Health Care Quality Measures for Medicaid" to ensure the effectiveness of the care provided.

Potential Impact

• For Individuals: This bill could provide a critical safety net for the most vulnerable populations who fall through the cracks of current insurance systems due to low income and severe behavioral health needs.
• For States: It provides states with a flexible tool to address mental health and addiction crises without requiring a full Medicaid expansion, allowing them to target resources specifically toward high-need behavioral health categories.
• For Healthcare Systems: It encourages the integration of care plans and quality reporting, potentially reducing the reliance on emergency departments for those with chronic mental health or substance use issues.

Procedural Status

• Introduced: December 3, 2025
• Sponsor: Rep. August Pfluger
• Committee: Referred to the House Committee on Energy and Commerce.