ANCHOR Act of 2025

The ANCHOR Act of 2025 (HR 6408), introduced by Rep. Pfluger (R-TX) on December 3, 2025, amends Title XIX of the Social Security Act to establish a state option for covering uninsured individuals with serious mental illness (SMI) or substance use disorder (SUD) at or below 100% of the federal poverty level. The bill has been referred to the House Energy and Commerce Committee; a companion bill (S 3300) has been read twice and referred to the Senate Finance Committee. The legislative status is early-stage, with no committee hearings, markups, or CBO score yet. The money trail is critical to understand: the ANCHOR Act authorizes a state option but does NOT appropriate any federal funds. Each state that elects the option must submit a state plan amendment (SPA) to CMS; federal matching funds (FMAP) would require subsequent annual appropriations through the regular appropriations process. The Congressional Budget Office has not scored this bill, though the Congressional Research Service would estimate costs based on take-up assumptions. Historical precedent from the ACA Medicaid expansion (which also provided a state option with enhanced FMAP) suggests that state adoption drives actual spending, and that the Centers for Medicare & Medicaid Services (CMS) must approve SPAs before coverage begins. Structural winners are pure-play Medicaid managed care insurers. Centene ($CNC) is the largest Medicaid managed care organization in the US by enrollment, operating in over 30 states. Its business model is directly levered to Medicaid membership growth. Molina Healthcare ($MOH) is the second-largest pure-play Medicaid insurer, with deep exposure to dual-eligible and behavioral health populations. Both companies have surged on expectation of this expansion: $CNC is up +62.4% in 30 days to $53.17, $MOH up +46.44% in 30 days to $195.22. Diversified insurers like UnitedHealth ($UNH, +36.11%) and Humana ($HUM, +39.15%) also benefit but have Medicaid as a smaller share of revenue, so the impact is less concentrated. The timeline is uncertain. No committee markup has been scheduled. The 119th Congress runs through January 2027, giving 8 months of legislative runway. State adoption would begin only after federal passage and CMS rulemaking, likely in 2027-2028. The April 2026 executive order accelerating mental health treatments provides regulatory tailwinds but is not directly linked to this bill's text.