Medicaid Improvement and State Flexibility Act of 2025

This bill would let states approve and run certain Medicaid pilot programs on their own, if the program follows set rules. People who choose to join would get an EBT card loaded by the state to pay for primary care and medicines. Any money left on the card at the end of the year would be paid to them in cash, and they would also need catastrophic health insurance to cover big medical bills and anything beyond the card amount.

The program is voluntary each year. States decide the card amount. The catastrophic plan must cover other services and kick in if the card runs out. Federal spending can’t be higher than it would have been without the pilot. The program cannot pay for abortions or plans that cover abortion, except to save the mother’s life or in cases of rape or incest. For these specific pilots, states—not the federal agency—could approve and renew them if all conditions are met.

• Who is affected: Medicaid enrollees in states that choose to run these pilots; state Medicaid programs.
• What changes: EBT card for primary care and medicines, cash-out of unused funds at year’s end, required catastrophic coverage, limits on abortion-related funding, and state approval authority with no increase in federal costs.
• When: People may choose to participate for one year at a time.