The "Bridge to Medicaid Act of 2025" aims to enhance access to affordable health insurance for low-income individuals, especially in states that have not expanded their Medicaid programs. It primarily achieves this by significantly increasing financial assistance for qualified health plans (QHPs) and expanding eligibility for premium tax credits, targeting individuals with household incomes up to 138% of the federal poverty line.

For plan years 2026 through 2028, the legislation mandates substantial reductions in cost-sharing for these "specified enrollees," ensuring their plans cover 99 percent of total allowed costs, with federal reimbursement to health plan issuers. Additionally, for 2026 and 2027, silver-level QHPs must provide specific additional benefits, such as non-emergency medical transportation and certain diagnostic or preventive services, without any cost-sharing, also with federal reimbursement.

The bill temporarily expands eligibility for premium tax credits from 2026 to 2028 by removing the 100% poverty line income floor and allowing low-income employees (up to 138% FPL) to receive credits even if offered employer-sponsored coverage. It also creates a continuous special enrollment period for these low-income individuals who are not eligible for other minimum essential coverage, while limiting the recapture of excess advance premium tax credits for lower-income taxpayers.

To ensure awareness and enrollment, the legislation directs the Secretary to conduct culturally and linguistically appropriate outreach and educational activities in non-expansion states, informing eligible individuals about available QHPs and financial assistance. It allocates significant funding for these efforts and strengthens the Navigator program in these states. The bill also provides an exemption for employers from shared responsibility penalties for employees (up to 138% FPL) who receive premium tax credits or cost-sharing reductions during the 2026-2028 period.

Finally, the bill adjusts the federal medical assistance percentage (FMAP) for newly eligible mandatory individuals under Medicaid expansion. It increases the federal share to 93 percent for calendar quarters in 2026, 2027, and 2028, before reverting to 90 percent for 2029 and subsequent years.