Medicaid Third Party Liability Act

House Votes

This bill changes how Medicaid works when a patient has other health coverage. Today, some claims get paid by Medicaid first and then billed to another insurer, like for children’s preventive checkups and for people in active child support cases. The bill ends these special exceptions, so other insurers must pay before Medicaid in those situations too .

States must also check and confirm whether a Medicaid patient has other insurance and which plan it is. If a state doesn’t get and verify this information, the federal government won’t pay its share for those services after January 1, 2026. When states work with health insurers or managed care plans, their contracts must spell out who is responsible for recovering money from other insurers and may let those plans act on the state’s behalf. After January 1, 2026, an authorization made under the state’s Medicaid plan counts as valid authorization for the other insurer to provide the item or service . States that need to pass new laws to comply get extra time until after their next regular legislative session closes.

Key points

• Who is affected: Medicaid patients (including children and families), state Medicaid programs, and health insurers/managed care plans.
• What changes: Ends Medicaid-pay-first exceptions for certain children’s and child-support-related services; requires states to verify other coverage; clarifies contracts so states or their plans can recover from other insurers .
• When: Most new requirements apply after January 1, 2026; states may have extra time if they need to pass state laws to comply .