Sponsors (2)
The bill expands flexibility and direct cash benefits for participating Medicaid enrollees and speeds state-level innovation, but shifts approval and spending incentives to states in ways that may reduce access, protections, and certain reproductive services for beneficiaries.
Medicaid beneficiaries can opt into a demonstration that gives an annual EBT card to pay for primary care and prescription drugs, increasing flexibility in how they access and pay for routine care.
Enrolled individuals can keep unused EBT funds as a year‑end cash payment, providing direct financial benefit and an incentive to manage care and costs.
States may design catastrophic insurance to cap participant liability beyond EBT limits, reducing the risk that enrollees face very high out‑of‑pocket medical expenses.
Women on Medicaid enrolled in these demonstrations face restricted coverage of abortion services (only allowed when life‑saving or in cases of rape or incest), reducing reproductive care access compared with broader state coverage.
Allowing states to self‑approve demonstrations reduces federal oversight, increasing the risk of inconsistent beneficiary protections and potential misuse of federal Medicaid funds.
Tying federal spending to not exceed projections could incentivize states to limit covered services or enrollment in demonstrations to reduce federal costs, potentially reducing access to care for low‑income beneficiaries.
Based on analysis of 2 sections of legislative text.
Permits states to self‑approve certain Medicaid 1115 demonstrations that use annual EBT allotments plus catastrophic coverage if budget neutrality and other conditions are met, and bans abortion coverage except narrow exceptions.
Official title: To amend title XI of the Social Security Act to provide for State approval and implementation of specified waivers under the Medicaid program.
Introduced February 4, 2025 by Mark E. Green · Last progress February 4, 2025
Allows states to self‑approve or renew certain Medicaid (section 1115) demonstration projects that waive State plan requirements if projects meet specific conditions. The projects must provide annual elective enrollment, give participating individuals a state‑determined EBT card for primary care and medications with unused funds returned as cash at year‑end, include state‑determined catastrophic coverage for other services, keep federal Medicaid spending no higher than baseline, and prohibit abortion coverage except in life‑saving, rape, or incest cases. The amendment shifts approval/renewal authority for these covered demonstrations from the federal Secretary to the State and adjusts statutory application and waiver‑limit language accordingly.