Sponsor
Mark James Desaulnier
Representative · D-CA
Representative · D-CA
The bill expands Medicaid-covered patient navigator services and funding to improve beneficiary access and care coordination, but it increases program costs and adds administrative and implementation hurdles that may delay or limit participation by smaller organizations and some states.
Medicaid beneficiaries will get covered access to patient navigator services to help enroll, coordinate care, and navigate services, improving access and care coordination.
State governments can receive federal Medicaid matching funds (FMAP) for navigator services, lowering net state costs for providing outreach and coordination.
Hospitals and community health organizations can bill Medicaid for navigator services, creating a new funding stream to support outreach and care coordination.
Taxpayers and state budgets could face higher overall Medicaid expenditures because newly reimbursable navigator services expand what the program pays for.
Medicaid beneficiaries and state governments in states that require enabling legislation may experience delays in access while states pass laws or update rules.
Smaller community-based organizations and nonprofits may face new administrative burdens and certification requirements to qualify as Medicaid providers or employ certified navigators.
Based on analysis of 2 sections of legislative text.
Requires Medicaid to reimburse qualified patient navigator services and makes those services eligible for federal FMAP matching.
Official title: To provide payment for patient navigator services under title XIX of the Social Security Act, and for other purposes.
Introduced September 10, 2026 by Mark James Desaulnier · Last progress September 10, 2026
Requires State Medicaid plans to reimburse eligible entities for patient navigator services provided to Medicaid beneficiaries and treats those services as medical assistance eligible for federal matching funds. Establishes definitions, training and qualification rules for patient navigators and authorizes a 3-year transitional allowance for HHS-approved training programs. Applies to services furnished after the first day of the first calendar year beginning after enactment, with a State-law delay option tied to the State legislature’s next regular session. The change makes payment for navigator services eligible for FMAP, sharing costs between the federal government and States under existing Medicaid matching rules.