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This bill would give states more power to set up and approve certain Medicaid waiver programs on their own. The main idea is to let states try a new kind of Medicaid arrangement where some people can choose a yearly option that gives them money on an electronic benefits card to buy primary care and medicines, plus extra insurance for bigger medical costs. If they do not spend all the money on the card, they would get the unused amount in cash at the end of the year. The bill also says these state-run projects must not cost the federal government more than current Medicaid spending, and it includes limits on using the program to pay for abortions, with only narrow exceptions.
- States could approve or renew certain Medicaid pilot or demonstration projects without waiting for federal approval.
- People enrolled in Medicaid could choose to take part in the project for one year.
- Participants would get an electronic benefits card for primary care visits and medications, plus a catastrophic insurance plan for other care and higher-cost needs.
- Any money left on the card at the end of the year would be paid to the person in cash, and the project could not increase federal Medicaid spending.
Official Summaries
Medicaid Improvement and State Flexibility Act of 2025
This bill authorizes states to approve their own experimental, pilot, or demonstration project under Medicaid if the project provides certain benefits involving electronic benefits transfer (EBT) cards. (Currently, the Centers for Medicare & Medicaid Services approves Medicaid demonstration projects; such projects are also known as Section 1115 Demonstrations.)
Specifically, the project must provide enrollees who elect to participate with an EBT card to purchase primary care services; enrollees must receive any remaining balance at the end of the year in the form of a cash payment and must also obtain catastrophic health insurance.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 936 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 936
To amend title XI of the Social Security Act to provide for State
approval and implementation of specified waivers under the Medicaid
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 4, 2025
Mr. Green of Tennessee (for himself and Mr. Brecheen) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to provide for State
approval and implementation of specified waivers under the Medicaid
program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicaid Improvement and State
Flexibility Act of 2025''.
SEC. 2. PROVIDING FOR STATE APPROVAL AND IMPLEMENTATION OF SPECIFIED
WAIVERS UNDER THE MEDICAID PROGRAM.
Section 1115 of the Social Security Act (42 U.S.C. 1315) is
amended--
(1) in subsection (d)--
(A) in paragraph (1), by striking ``An
application'' and inserting ``Subject to paragraph (4),
an application''; and
(B) by adding at the end the following new
paragraph:
``(4)(A) An experimental, pilot, or demonstration project
undertaken under subsection (a) may be approved or renewed by a State
if such project is described in subparagraph (B).
``(B) An experimental, pilot, or demonstration project is described
in this subparagraph if such project provides for a waiver of
requirements with respect to a State plan (or a waiver of such plan)
under title XIX such that--
``(i) individuals enrolled under such plan (or such waiver)
may elect to participate in such project with respect to a
year;
``(ii) such individuals who elect to so participate--
``(I) are furnished with an electronic benefits
transfer card in an amount determined appropriate by
the State for purposes of purchasing primary care
services and medications during such year;
``(II) are furnished a cash payment by the State
equal to the amount of funds remaining on the
individual's electronic benefits transfer card at the
end of such year; and
``(III) are enrolled in a catastrophic insurance
program determined appropriate by the State for
purposes of covering services not described in
subclause (I) and covering services that are described
in such subclause if such individual exceeds the amount
of funds provided to such individual on such card for
such year; and
``(iii) Federal expenditures under such title for the
period during which such project is in effect are equal to or
lesser than what such expenditures would have been during such
period if such project were not in effect.
``(C)(i) In no case may a project described in subparagraph (B)
result in an expenditure to pay for any abortion or to assist in the
purchase, in whole or in part, of health benefit coverage that includes
coverage of abortion.
``(ii) Clause (i) shall not apply to an abortion only if necessary
to save the life of the mother or if the pregnancy is the result of an
act of rape or incest.
``(D) For purposes of a State's approval or renewal of an
experimental, pilot, or demonstration project under subparagraph (A),
each reference to `the Secretary' in subsection (a) shall be deemed to
be a reference to `the State'.''; and
(2) in subsection (e), by inserting ``(other than such a
project that is described in paragraph (4)(B))'' before the
period at the end.
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