II
119THCONGRESS
1
STSESSION S. 523
To amend title XIX of the Social Security Act to prohibit Federal Medicaid
funding for the administrative costs of providing health benefits to indi-
viduals who are unauthorized immigrants.
IN THE SENATE OF THE UNITED STATES
FEBRUARY11, 2025
Mr. C
ASSIDY(for himself, Mr. BARRASSO, Mr. WICKER, and Mrs. HYDE-
S
MITH) introduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To amend title XIX of the Social Security Act to prohibit
Federal Medicaid funding for the administrative costs
of providing health benefits to individuals who are unau-
thorized immigrants.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Protect Medicaid Act’’. 4
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•S 523 IS
SEC. 2. PROHIBITING FEDERAL MEDICAID FUNDING FOR 1
THE ADMINISTRATIVE COSTS OF PROVIDING 2
HEALTH BENEFITS TO INDIVIDUALS WHO 3
ARE UNAUTHORIZED IMMIGRANTS. 4
Section 1903(i) of the Social Security Act (42 U.S.C. 5
1396b(i)) is amended— 6
(1) in paragraph (26), by striking ‘‘; or’’ and 7
inserting a semicolon; 8
(2) in paragraph (27), by striking the period at 9
the end and inserting ‘‘; or’’; and 10
(3) by inserting after paragraph (27) the fol-11
lowing new paragraph: 12
‘‘(28) with respect to any amounts expended for 13
the administration of a State program that provides 14
health benefits to noncitizens who are ineligible for 15
medical assistance under this title on the basis of 16
not having a satisfactory immigration status (as de-17
fined in section 1137(d)(1)(B)(iii)) (except that such 18
prohibition shall not be construed as prohibiting 19
payment under the preceding provisions of this sec-20
tion for costs attributable to the establishment or 21
operation of a system designed to ensure compliance 22
with such prohibition).’’. 23
SEC. 3. INSPECTOR GENERAL REPORT. 24
Not later than 180 days after the date of enactment 25
of this Act, the Inspector General of the Department of 26
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•S 523 IS
Health and Human Services shall submit to Congress a 1
report that includes the following information with respect 2
to States that provide health benefits to noncitizens who 3
are ineligible on the basis of immigration status for med-4
ical assistance under title XIX of the Social Security Act 5
(42 U.S.C. 1396 et seq.): 6
(1) How such States separate amounts ex-7
pended on the administrative costs related to the 8
State’s Medicaid program and amounts expended on 9
administrative costs related to providing health ben-10
efits to such noncitizens. 11
(2) The types of procedures, protocols, or sys-12
tems that such States employ to ensure that they 13
are in full compliance with prohibitions on the use 14
of Federal funding to provide health benefits to such 15
noncitizens and how effective they are at ensuring 16
compliance. 17
(3) A description of States’ methods of financ-18
ing State programs that provide health benefits to 19
noncitizens who are ineligible for medical assistance 20
due to not having a satisfactory immigration status, 21
including through the increased use of provider taxes 22
and intergovernmental transfers to finance the non- 23
Federal share of expenditures under the State Med-24
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•S 523 IS
icaid program for medical assistance provided to in-1
dividuals who are not so ineligible. 2
(4) An analysis of— 3
(A) the extent to which such noncitizens 4
are provided covered outpatient drugs pur-5
chased under— 6
(i) the Medicaid Drug Rebate Pro-7
gram under section 1927 of the Social Se-8
curity Act (42 U.S.C. 1396r–8); or 9
(ii) the drug discount program under 10
section 340B of the Public Health Service 11
Act (42 U.S.C. 256b); and 12
(B) the effect that the provision to such 13
noncitizens of covered outpatient drugs pur-14
chased under the programs described in sub-15
paragraph (A) has on the average manufacturer 16
price (as defined in section 1927(k)(1) of the 17
Social Security Act (42 U.S.C. 1396r–8(k)(1))) 18
of such drugs, including whether the average 19
manufacturer price for such drugs would be 20
lower if no drugs purchased under such pro-21
grams were provided to such noncitizens. 22
Æ
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