HB242 Alabama 2025 Session

Summary

Primary Sponsor

Phillip RigsbyRepresentative

Republican

Session

2025 Regular Session

Title

Medicaid, to require coverage of rapid whole genome sequencing

Summary

This bill would require Alabama Medicaid to cover rapid whole genome sequencing for certain hospitalized patients under 21 when the illness has an unknown genetic cause.

What This Bill Does

Medicaid would pay for rapid whole genome sequencing for eligible Medicaid recipients who are hospitalized with acute or complex illnesses of unknown etiology. It allows either patient-only sequencing or duo/trio sequencing that includes the patient and biological parents. Coverage is subject to prior approval or a CMS waiver, and the sequencing turnaround is defined as a preliminary result within five days and a final result within 14 days. The changes take effect on October 1, 2025.

Who It Affects

• Medicaid-enrolled patients age 21 or younger who are in an ICU, NICU, or high-acuity hospital unit with an illness of unknown cause.
• Families of those patients, since trio sequencing (patient plus biological parents) may be used and parental genetic information may be involved.

Key Provisions

• Defines rapid whole genome sequencing as sequencing the entire human genome (coding, non-coding regions, and mitochondrial DNA) with a preliminary positive result within five days and a final result within 14 days.
• Requires the Alabama Medicaid Agency to cover rapid whole genome sequencing for eligible individuals, subject to prior approval or a waiver from the Centers for Medicare and Medicaid Services (CMS).
• Eligibility criteria: individual must be 21 years old or younger; have a complex or acute illness of unknown etiology not explained by environmental exposure, infection that responds to therapy, or trauma; and be a hospital inpatient in an ICU, NICU, or high-acuity pediatric unit.
• Allows either patient-only sequencing or duo/trio sequencing (the patient and biological parents).
• Effective date: October 1, 2025.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health