Medicaid Improvement and State Flexibility Act of 2025This bill authorizes states to approve their own experimental, pilot, or demonstration project under Medicaid if the project provides certain benefits involving electronic benefits transfer (EBT) cards. (Currently, the Centers for Medicare & Medicaid Services approves Medicaid demonstration projects; such projects are also known as Section 1115 Demonstrations.)Specifically, the project must provide enrollees who elect to participate with an EBT card to purchase primary care services; enrollees must receive any remaining balance at the end of the year in the form of a cash payment and must also obtain catastrophic health insurance.
Impact
One of the key aspects of the bill is the emphasis on state-level approval for waiver projects. States would be empowered to offer the option of being furnished with benefits on an electronic card, which beneficiaries could use for primary care and medications. Furthermore, they would receive a cash payment equivalent to the balance remaining on the card at the end of the year. This clause intends to place healthcare purchasing decisions into the hands of beneficiaries, thereby fostering a more consumer-driven approach to Medicaid. The bill also mandates that any demonstration project must yield federal expenditure levels that are equal to or less than current costs under Medicaid.
Summary
House Bill 936, titled the 'Medicaid Improvement and State Flexibility Act of 2025', proposes significant changes to the way Medicaid waivers are managed by allowing individual states to approve and implement certain types of waivers. This bill aims to provide states with greater flexibility in developing experimental, pilot, or demonstration projects under Medicaid, which would lead to new approaches for delivering healthcare services to beneficiaries. The proponents argue that this decentralization will encourage innovative solutions tailored to the specific needs of state populations while potentially improving efficiency in Medicaid service delivery.
Contention
While the potential benefits of increased state flexibility are acknowledged, the bill also faces notable opposition. Critics express concern over the bill's stipulation regarding the prohibition of using funds for abortion services, except in specific circumstances. This provision may spark debates surrounding access to comprehensive reproductive healthcare within the Medicaid framework. Additionally, there are apprehensions about whether the implementation of such waivers might compromise the uniformity of Medicaid standards across states, potentially resulting in disparities in healthcare access and quality of care. Legislators and advocacy groups are likely to scrutinize the bill’s implications on abortion funding, as well as its broader effects on healthcare equity.
Cover Outstanding Vulnerable Expansion-eligible Residents Now Act or the COVER Now Act This bill establishes a demonstration program to allow local governments to provide health benefits to the Medicaid expansion population in states that have not expanded Medicaid. Under the program, local governments may provide coverage for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (i.e., the Medicaid expansion population) for a maximum of 10 years, or until their respective states expand Medicaid. The bill provides a 100% federal matching rate for the first three years of program participation. The bill prohibits states from taking certain actions against participating localities, such as withholding funding, increasing taxes, or restricting provider participation. States that violate these requirements are subject to certain funding penalties.
Advanced Safe Testing at Residence Telehealth Act of 2023 This bill temporarily establishes several programs to provide telehealth services for at-home testing, evaluations, and other health care. Specifically, the bill establishes a demonstration program to provide assistive telehealth consultations and home- and community-based care for certain Medicare beneficiaries through Medicare Advantage (MA) plans. Covered services include certain at-home diagnostic tests, telehealth consultations, transportation services, and meal benefits. Beneficiaries must be (1) age 65 or older and eligible to enroll in a qualifying MA plan and to receive certain low-income subsidies under the Medicare prescription drug benefit, or (2) dually eligible for Medicare and Medicaid benefits. The bill also establishes a grant program for state Medicaid programs to cover similar at-home tests and related telehealth consultations. Additionally, the Department of Veterans Affairs must establish a pilot program to provide tests and related telehealth consultations free of charge to veterans.
Language Access for Medicare Beneficiaries Act of 2023 This bill requires the Centers for Medicare & Medicaid Services (CMS) to translate the annual explanation of Medicare benefits for enrollees into multiple languages, besides English and Spanish. The CMS must prioritize languages into which Social Security documents are translated or that are most frequently requested for purposes of Social Security benefits applications.
To amend title XVIII of the Social Security Act to provide for the guaranteed issue of Medigap policies to all Medigap-eligible Medicare beneficiaries and Medicare Advantage enrollees, and for other purposes.