Sponsors (2)
This bill offers Medicaid enrollees greater cash-like flexibility and state-tailored demonstrations to manage routine care costs, but it increases state control and spending constraints that could reduce coverage, weaken federal protections, and limit reproductive-care access.
Medicaid beneficiaries can opt into a demonstration that gives them an annual EBT-style benefit to pay for primary care and prescription drugs, increasing flexibility in how they access and spend on routine care.
Enrolled participants receive year-end cash payments for any unused EBT balance, providing direct financial benefit and a personal incentive to manage care and costs.
States may design catastrophic insurance protections for demonstration participants to limit exposure to very high medical costs beyond EBT limits, reducing the risk of catastrophic out-of-pocket spending.
The requirement that federal spending not exceed projections could push states to limit covered services or restrict enrollment to contain costs, reducing access to care for Medicaid beneficiaries.
Giving states self-approval authority for these demonstrations reduces federal oversight and increases the risk of inconsistent consumer protections or improper use of federal Medicaid funds.
The demonstrations prohibit coverage of abortion except when the pregnancy endangers the woman's life or results from rape or incest, restricting reproductive-care access for Medicaid enrollees compared with broader state coverage in some places.
Based on analysis of 2 sections of legislative text.
Allows States to self-approve certain Medicaid 1115 demonstrations that use EBT-based primary care benefits, annual beneficiary choice, and State catastrophic insurance if federal costs do not rise and abortion coverage is limited.
Allows States to self-approve or renew certain Medicaid (section 1115) demonstration projects if the demonstration meets specified conditions. Those conditions include annual beneficiary enrollment choice, use of a State-set electronic benefits transfer (EBT) card for primary care and medications with cashback for unused funds, State-provided catastrophic insurance, a requirement that federal Medicaid spending not exceed what it would have been otherwise, and a restriction preventing the project from paying for abortion except to save the life of the pregnant person or in cases of rape or incest. The bill also creates a short title for the Act and shifts approval authority for these covered demonstrations from the federal Secretary to the State and excludes them from an existing statutory waiver limit.
Introduced February 4, 2025 by Mark E. Green · Last progress February 4, 2025