HR 936 — Medicaid Improvement and State Flexibility Act of 2025

Summary

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.

Bill Text

• Introduced Introduced in House Current html February 04, 2025

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill modifies the approval process for Medicaid demonstration projects, allowing states more authority to implement certain waivers.

• 42 U.S.C. 1315

  An application → Subject to paragraph (4), an application

  The bill specifies that state approval of waiver applications is subject to new conditions.

• 42 U.S.C. 1315

  (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).

  The bill allows states to approve or renew certain demonstration projects, enhancing state flexibility.

• 42 U.S.C. 1315

  (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--

  Defines the criteria for state-approved demonstration projects under Medicaid.

• 42 U.S.C. 1315

  (i) individuals enrolled under such plan (or such waiver) may elect to participate in such project with respect to a year;

  Allows individuals to opt into demonstration projects, increasing participant choice.

• 42 U.S.C. 1315

  (ii) such individuals who elect to so participate--

  Introduces requirements for benefits provided to participants in these projects.

• 42 U.S.C. 1315

  (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;

  Mandates that participating individuals receive an electronic benefits transfer card for health services.

• 42 U.S.C. 1315

  (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;

  Ensures participants receive cash payments equal to their remaining benefits, promoting financial security.

• 42 U.S.C. 1315

  (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;

  Requires enrollment of participants in catastrophic insurance for additional protection.

• 42 U.S.C. 1315

  (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.

  Ensures that federal spending remains controlled during the project duration.

• 42 U.S.C. 1315

  (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.

  Prohibits federal spending on abortion through these demonstration projects, except under certain circumstances.

• 42 U.S.C. 1315

  (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.

  Clarifies exceptions for federal funding regarding abortion.

• 42 U.S.C. 1315

  (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'.

  Changes references in the law so that state authorities are treated similarly to the Secretary regarding project approvals.

• 42 U.S.C. 1315

  (2) in subsection (e), by inserting ``(other than such a project that is described in paragraph (4)(B))'' before the period at the end.

  Specifies that certain projects described in the new paragraph do not fall under existing provisions.

Action History

1. February 04, 2025

   Introduced in House

2. February 04, 2025

   Introduced in House

3. February 04, 2025

   Referred to the House Committee on Energy and Commerce.

Sponsors

• Mark E. Green · Primary
• Josh Brecheen · Cosponsor

Subjects