Sponsors (4)
The bill strengthens Medicaid program integrity and patient safety by requiring routine checks against a federal exclusion database, but imposes implementation costs on states and risks provider disruption or erroneous exclusions that could restrict beneficiary access.
State Medicaid programs and taxpayers will more quickly identify and exclude providers terminated for fraud or program violations, reducing improper payments and strengthening program integrity.
Medicaid patients—especially those with chronic conditions—will likely face fewer encounters with providers who have been terminated for fraud or noncompliance, improving care safety.
State Medicaid agencies will adopt a standardized verification practice using the PPACA §6401(b)(2) database, improving consistency, transparency, and coordination across States' enrollment and oversight processes.
State Medicaid agencies will incur additional administrative and IT costs to implement monthly checks and integrate database access, creating budgetary and operational burdens.
Hospitals and other providers could face increased risk of wrongful or delayed enrollment terminations if database records are inaccurate or not corrected in time, harming providers and potentially disrupting patient care.
Medicaid beneficiaries—particularly in areas with few providers—could experience reduced access to care if monthly monitoring discourages provider participation in Medicaid.
Based on analysis of 2 sections of legislative text.
Introduced March 5, 2025 by Nicholas A. Langworthy · Last progress March 5, 2025
Requires States, beginning January 1, 2028, to check a federal/state database (created under the Affordable Care Act) when enrolling, reenrolling, or revalidating Medicaid providers and at least monthly while providers remain enrolled to see if those providers were terminated from Medicare or from any other State’s Medicaid or CHIP program. The amendment updates the Medicaid provider screening rule to add this recurring database check but does not provide funding or change other program eligibility rules.