What This Bill Does
This bill changes rules for Medicaid waivers (special approvals that let states run test programs that don't follow normal Medicaid rules). Instead of the federal government approving these test projects, states can now approve and run certain types of projects on their own. The bill allows states to set up programs where people get a prepaid card for basic health care costs.
Who It Affects
People enrolled in Medicaid (government health insurance for low-income individuals and families). States that run Medicaid programs. The federal government.
Key Provisions
• States can approve and renew experimental, pilot or demonstration projects without federal approval if they meet specific conditions (Sec. 2(4)(A)).
• People enrolled in these state-approved projects can choose whether to participate, and if they do, they receive an electronic benefits transfer card (a prepaid card) in an amount the state decides for buying primary care services and medications each year (Sec. 2(4)(B)(i) and (ii)(I)).
• People who participate get paid back any unused money remaining on their card at the end of the year, and they must be enrolled in catastrophic insurance (coverage for expensive emergencies or when card funds run out) that the state chooses (Sec. 2(4)(B)(ii)(II) and (III)).
• The federal government cannot spend more money on these state projects than it would have spent on regular Medicaid during the same time period (Sec. 2(4)(B)(iii)).
• These state-approved projects cannot use federal money to pay for abortions, except in cases where abortion is necessary to save the mother's life or when pregnancy results from rape or incest (Sec. 2(4)(C)).
What Changes
Currently, the federal government must approve Medicaid waiver projects. This bill allows states to approve specific types of waiver projects themselves. States gain the power to decide the amount of money on prepaid cards, choose catastrophic insurance plans, and determine other project details that the federal government previously controlled.
Important Definitions
Experimental, pilot or demonstration project: A test program designed to try new ways of providing Medicaid services (Sec. 2(4)).
Electronic benefits transfer card: A prepaid card that holds money for purchasing primary care services and medications.
Catastrophic insurance: Insurance coverage that pays for major medical expenses and services not covered by the prepaid card amount.
I
118TH CONGRESS
1ST SESSION
H. R. 629
To amend title XI of the Social Security Act to provide for State approval
and implementation of specified waivers under the Medicaid program.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 30, 2023
Mr. GREEN of Tennessee (for himself and Mr. BRECHEEN) introduced the
following bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend title XI of the Social Security Act to provide
for State approval and implementation of specified waiv-
ers under the Medicaid program.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Medicaid Improvement
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and State Flexibility Act of 2023’’.
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SEC. 2. PROVIDING FOR STATE APPROVAL AND IMPLEMEN-
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TATION OF SPECIFIED WAIVERS UNDER THE
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MEDICAID PROGRAM.
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Section 1115 of the Social Security Act (42 U.S.C.
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1315) is amended—
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•HR 629 IH
(1) in subsection (d)—
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(A) in paragraph (1), by striking ‘‘An ap-
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plication’’ and inserting ‘‘Subject to paragraph
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(4), an application’’; and
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(B) by adding at the end the following new
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paragraph:
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‘‘(4)(A) An experimental, pilot, or demonstration
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project undertaken under subsection (a) may be approved
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or renewed by a State if such project is described in sub-
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paragraph (B).
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‘‘(B) An experimental, pilot, or demonstration project
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is described in this subparagraph if such project provides
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for a waiver of requirements with respect to a State plan
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(or a waiver of such plan) under title XIX such that—
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‘‘(i) individuals enrolled under such plan (or
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such waiver) may elect to participate in such project
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with respect to a year;
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‘‘(ii) such individuals who elect to so partici-
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pate—
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‘‘(I) are furnished with an electronic bene-
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fits transfer card in an amount determined ap-
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propriate by the State for purposes of pur-
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chasing primary care services and medications
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during such year;
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‘‘(II) are furnished a cash payment by the
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State equal to the amount of funds remaining
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on the individual’s electronic benefits transfer
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card at the end of such year; and
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‘‘(III) are enrolled in a catastrophic insur-
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ance program determined appropriate by the
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State for purposes of covering services not de-
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scribed in subclause (I) and covering services
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that are described in such subclause if such in-
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dividual exceeds the amount of funds provided
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to such individual on such card for such year;
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and
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‘‘(iii) Federal expenditures under such title for
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the period during which such project is in effect are
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equal to or lesser than what such expenditures would
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have been during such period if such project were
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not in effect.
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‘‘(C)(i) In no case may a project described in sub-
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paragraph (B) result in an expenditure to pay for any
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abortion or to assist in the purchase, in whole or in part,
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of health benefit coverage that includes coverage of abor-
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tion.
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‘‘(ii) Clause (i) shall not apply to an abortion only
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if necessary to save the life of the mother or if the preg-
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nancy is the result of an act of rape or incest.
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‘‘(D) For purposes of a State’s approval or renewal
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of an experimental, pilot, or demonstration project under
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subparagraph (A), each reference to ‘the Secretary’ in
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subsection (a) shall be deemed to be a reference to ‘the
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State’.’’; and
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(2) in subsection (e), by inserting ‘‘(other than
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such a project that is described in paragraph
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(4)(B))’’ before the period at the end.
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Æ
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