Sponsors (46)
The bill makes it easier and faster for Medicaid/CHIP children and beneficiaries to get care from out-of-state providers and encourages provider participation, but shifts costs and reduces some state oversight and screening controls—raising risks of fraud, compliance problems, and implementation burdens for states.
Children under 21 enrolled in Medicaid or CHIP can access out-of-state providers more quickly because enrollment is streamlined and CHIP rules are aligned with Medicaid, expanding available care options for covered children.
Medicaid and CHIP providers face a simpler, faster enrollment process that reduces administrative burden and speeds reimbursement, encouraging more providers (including hospitals and clinicians) to serve Medicaid/CHIP patients.
Out-of-state providers who enroll remain approved for five years, improving continuity of care and sustaining provider availability for beneficiaries who rely on cross-state services.
Shorter screening and a faster enrollment process could increase fraud or improper payments if minimal checks miss ineligible or problematic providers, exposing taxpayers and state programs to financial losses.
Mandating five-year enrollment periods limits States' ability to quickly remove providers who become noncompliant or problematic, raising payment, compliance, and beneficiary-safety risks.
States will incur implementation costs to build and operate the streamlined enrollment system (staffing, IT upgrades), creating new budgetary pressures on state governments.
Based on analysis of 2 sections of legislative text.
Requires States to adopt a streamlined Medicaid enrollment process for eligible out-of-State providers serving Medicaid enrollees under age 21, with five-year enrollment and minimal documentation.
Official title: Amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines.
Introduced February 26, 2025 by Charles Ernest Grassley · Last progress February 26, 2025
Requires State Medicaid programs to adopt a streamlined enrollment process that lets eligible out-of-State providers enroll to furnish, order, prescribe, refer, or certify Medicaid services for children and youth under age 21 without burdensome screening beyond basic payment-related information. Enrolled out-of-State providers remain enrolled for five years unless terminated or excluded; the rule applies to the 50 States and DC and takes effect three years after enactment.