Medicaid Improvement and State Flexibility Act of 2025This 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.
Impact
One of the key aspects of the bill is the emphasis on state-level approval for waiver projects. States would be empowered to offer the option of being furnished with benefits on an electronic card, which beneficiaries could use for primary care and medications. Furthermore, they would receive a cash payment equivalent to the balance remaining on the card at the end of the year. This clause intends to place healthcare purchasing decisions into the hands of beneficiaries, thereby fostering a more consumer-driven approach to Medicaid. The bill also mandates that any demonstration project must yield federal expenditure levels that are equal to or less than current costs under Medicaid.
Summary
House Bill 936, titled the 'Medicaid Improvement and State Flexibility Act of 2025', proposes significant changes to the way Medicaid waivers are managed by allowing individual states to approve and implement certain types of waivers. This bill aims to provide states with greater flexibility in developing experimental, pilot, or demonstration projects under Medicaid, which would lead to new approaches for delivering healthcare services to beneficiaries. The proponents argue that this decentralization will encourage innovative solutions tailored to the specific needs of state populations while potentially improving efficiency in Medicaid service delivery.
Contention
While the potential benefits of increased state flexibility are acknowledged, the bill also faces notable opposition. Critics express concern over the bill's stipulation regarding the prohibition of using funds for abortion services, except in specific circumstances. This provision may spark debates surrounding access to comprehensive reproductive healthcare within the Medicaid framework. Additionally, there are apprehensions about whether the implementation of such waivers might compromise the uniformity of Medicaid standards across states, potentially resulting in disparities in healthcare access and quality of care. Legislators and advocacy groups are likely to scrutinize the bill’s implications on abortion funding, as well as its broader effects on healthcare equity.
No Abortion Coverage for Medicaid ActThis bill prohibits the Centers for Medicare & Medicaid Services from approving experimental, pilot, or demonstration projects under Medicaid (also known as Section 1115 Demonstrations) if the project provides federal financial assistance for abortions or for health benefits that include abortions, including expenses for related travel or lodging.The bill's restrictions do not apply to abortions in the cases of rape or incest; treatments to address life-threatening physical disorders, injuries, or illnesses; or treatments for miscarriages or ectopic pregnancies.
Kids' Access to Primary Care Act of 2025This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.
JOINT RESOLUTION TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUESTS AND RENEWALS -- RHODE ISLAND MEDICAID REFORM ACT OF 2008 (Joint resolution to approve an amendment to the Medicaid section 1115 demonstration waiver requests and renewals.)
JOINT RESOLUTION TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUESTS AND RENEWALS -- RHODE ISLAND MEDICAID REFORM ACT OF 2008 (Joint resolution to approve an amendment to the Medicaid section 1115 demonstration waiver requests and renewals.)
Protect Medicaid Act This bill prohibits federal payment under Medicaid for the administrative costs of providing health benefits to noncitizens who are ineligible for Medicaid based on their immigration status. The Department of Health and Human Services must report on specified information regarding states that provide health benefits to such individuals.
JOINT RESOLUTION TO AMEND THE MEDICAID SECTION 1115 DEMONSTRATION WAIVER REQUESTS AND RENEWALS (Amends the Medicaid section 1115 demonstration waiver requests and renewals.)
Requiring the secretary of health and environment to request a waiver from the United States centers for medicare and medicaid services to end participation in certain expenditure authorities under the KanCare demonstration.
Advancing Enrollment and Reducing Drug Costs ActThis bill specifies that certain Medicaid enrollees automatically qualify for low-income subsidies under the Medicare prescription drug benefit. Specifically, the bill automatically qualifies individuals who were enrolled in Medicaid before they turned 65 (as part of Medicaid expansion under the Patient Protection and Affordable Care Act) and whose income is below 200% of the federal poverty line.