Medicaid

Current understanding

Federal rules and legislation affecting Medicaid eligibility, coverage, and program administration by CMS and state Medicaid agencies. CMS has finalized a rule imposing community engagement (work) requirements on certain Medicaid enrollees as a condition of eligibility, which shifts what beneficiaries must do to remain covered.

Evidence log

• 2026-08-13 — Medicaid Program; Prohibition on Federal Medicaid and Children’s Health Insurance Program Funding for Sex-Rejecting Procedures Furnished to Children: 2026 — CMS Final Rule, Prohibition on Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures Furnished to Children: bars federal Medicaid and CHIP payment for sex-rejecting procedures (surgeries, cross-sex hormones, puberty blockers for gender transition) for minors, with a limited wind-down period for children already receiving cross-sex hormones. (novelty: 4)
• 2025-04-29 — Medicaid Empowerment Act of 2025: 2025 — Medicaid Empowerment Act of 2025 (introduced): would extend Section 1915© HCBS waiver renewal periods from 5 to 10 years, reducing state and CMS administrative renewal burden without changing waiver eligibility or benefits. (novelty: 2) (novelty: 2)
• 2025-07-30 — Protecting Health Care and Lowering Costs Act: 2026 — Protecting Health Care and Lowering Costs Act (S2556, introduced): would repeal multiple Medicaid provisions enacted by the OBBBA, reversing recent statutory changes to Medicaid eligibility, financing, or coverage rules. (novelty: 3)
• 2025-02-18 — LIVE Beneficiaries Act: 2025 — LIVE Beneficiaries Act (introduced): would require state Medicaid programs to check the SSA Death Master File at least quarterly to identify and disenroll deceased beneficiaries as a program-integrity measure. (novelty: 2)
• 2025-02-13 — Protecting America’s Seniors’ Access to Care Act: 2026 — Protecting America’s Seniors’ Access to Care Act (introduced): would bar CMS from enforcing the May 2024 LTC staffing rule and its requirement that states report on Medicaid payments to direct care workers, removing a state Medicaid transparency mandate. (novelty: 2)
• 2025-02-05 — Medicaid Program Improvement Act: 2026 — Medicaid Program Improvement Act (introduced): would codify statutory requirements that state Medicaid and CHIP programs maintain processes for obtaining updated enrollee addresses and require contracted managed care plans to report enrollee-verified addresses to states. (novelty: 2) (novelty: 2)
• 2026-01-27 — Ensuring Access to Medicaid Buy-in Programs Act of 2026: 2026 — Ensuring Access to Medicaid Buy-in Programs Act of 2026 (S3690, introduced): referred to Senate Finance; would address access to Medicaid buy-in programs, which allow working individuals with disabilities to purchase Medicaid coverage above standard income/asset limits. (novelty: 2)
• 2026-07-22 — Medicaid Dental Benefit Act of 2026: 2026 — Medicaid Dental Benefit Act of 2026 (HR9831, introduced): referred to House Energy and Commerce; would establish or expand dental benefits under Medicaid, potentially adding a currently optional adult benefit category to state programs. (novelty: 2) (novelty: 2)
• 2026-06-11 — Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2027: 2026-06-11 — Labor-HHS-Education Appropriations FY2027 (HR9260, placed on Union Calendar): would provide FY2027 discretionary appropriations to CMS for program management and oversight functions supporting Medicaid administration; benefit spending remains on the mandatory side. (novelty: 2)
• 2025-12-11 — Health Care Freedom for Patients Act of 2025: 2025 — Health Care Freedom for Patients Act of 2025 (introduced): would reduce the Medicaid expansion FMAP for states that cover non-qualified aliens and bar Medicaid and CHIP payment for gender-transition procedures. (novelty: 3)
• 2026-07-29 — A bill to amend titles XI, XIX, and XXI of the Social Security Act with respect to screening for childhood-onset fluency disorders, and to require coverage of certain speech therapy services under Medicaid and CHIP.: 2025 — S5172 (introduced): would amend SSA titles XI, XIX, and XXI to require Medicaid and CHIP coverage of screening for childhood-onset fluency disorders and certain speech therapy services, expanding mandated benefits for affected children. (novelty: 2) (novelty: 2)
• 2026-07-29 — A bill to amend titles XVIII and XIX of the Social Security Act to make improvements relating to the designation of rural emergency hospitals.: 2025 — S5164 (introduced): would amend Medicaid Title XIX alongside Medicare to improve the designation of rural emergency hospitals, extending REH-related changes into state Medicaid rules. (novelty: 2)
• 2026-07-22 — Ensuring Kids Have Access to Medically Necessary Dental Care Act: 2025 — Ensuring Kids Have Access to Medically Necessary Dental Care Act (S5088, introduced): referred to Senate Finance; would address pediatric access to medically necessary dental care, a benefit category primarily delivered through Medicaid/CHIP EPSDT. (novelty: 2)
• 2025-03-10 — Further Additional Continuing Appropriations and Other Extensions Act, 2025: 2025 — Further Additional Continuing Appropriations and Other Extensions Act, 2025 (enacted): extends expiring Medicaid authorities as part of a short-term CR through April 11, 2025, without altering eligibility or benefit rules. (novelty: 2)
• 2025-04-02 — EASE Act: 2025 — EASE Act (S1248, introduced): the proposed CMMI rural telehealth specialty care model would extend to Medicaid and CHIP beneficiaries served by nonprofit safety-net provider networks. (novelty: 3)
• 2025-04-01 — ABC Act: 2025 — ABC Act (HR2491, introduced): confirms Medicaid and CHIP eligibility, application, forms, and communications processes are within the CMS review-and-streamline mandate for family caregivers, with states encouraged to conduct parallel reviews. (novelty: 3)
• 2025-04-01 — EASE Act of 2025: 2025 — EASE Act of 2025 (introduced): would extend a proposed CMMI telehealth specialty-care demonstration to rural Medicaid and CHIP beneficiaries via safety-net providers (FQHCs, RHCs, CAHs, REHs). (novelty: 3)
• 2025-03-31 — ABC Act: 2025 — ABC Act (HR2491, introduced): would direct CMS to streamline Medicaid and CHIP eligibility, application, forms, and communications processes for family caregivers and encourage parallel state-level reviews. (novelty: 2) (novelty: 2)
• 2025-03-14 — Block Organ Transplant Purchases from China Act of 2025: 2025 — Block Organ Transplant Purchases from China Act of 2025 (HR2114, introduced): would prohibit Medicaid from covering organ transplants performed in China or using organs not procured through the U.S. OPTN. (novelty: 3)
• 2026-07-23 — To amend title XIX of the Social Security Act to provide a temporary higher Federal medical assistance percentage for Federal expenditures under the Medicaid program that are associated with the cost of compliance with certain Federal regulations with respect to services furnished in certain intermediate care facilities or home and community-based services furnished to individuals with intellectual and developmental disabilities.: 2026 — HR9940 (introduced): would temporarily raise the Federal Medical Assistance Percentage for state Medicaid spending tied to complying with certain federal regulations governing intermediate care facilities (ICF/IID) and home- and community-based services for individuals with intellectual and developmental disabilities. (novelty: 2) (novelty: 2)
• 2026-05-19 — IMPACT to Save Moms Act: 2025 — IMPACT to Save Moms Act (HR8907, introduced): would create a multi-year CMS demonstration through FY2031 for state-tested alternative payment models covering perinatal and postpartum care under Medicaid and CHIP. (novelty: 3)
• 2026-07-23 — Medicaid Program; Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes: 2026 — CMS Proposed Rule, Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes: would align Medicaid provider tax indirect hold harmless thresholds with WFTC statutory phase-downs effective October 2026–2027, sunset a secondary determination prong, and add a new permissible tax class for enhanced oversight, potentially reducing state financing capacity for Medicaid. (novelty: 3)
• 2026-06-24 — LIFT the BAR Act: 2026 — LIFT the BAR Act (HR9432, introduced): would repeal PRWORA-era eligibility bars, restoring lawfully present immigrants’ access to federal means-tested benefits including Medicaid and CHIP; referred to multiple committees including Energy and Commerce (novelty: 2). (novelty: 2)
• 2026-03-05 — PrEP Access and Coverage Act of 2026: 2026 — PrEP Access and Coverage Act of 2026 (HR7853, introduced): referred to House Energy and Commerce, implicating Medicaid coverage and cost-sharing rules for HIV pre-exposure prophylaxis. (novelty: 2) (novelty: 2)
• 2026-04-28 — HCBS Access Act: 2026-04-28 — HCBS Access Act (HR8540, introduced): would address access to Medicaid-financed home and community-based services; multi-committee referral including Energy and Commerce. (novelty: 2)
• 2025-01-04 — Think Differently Database Act: 2025 — Think Differently Database Act (enacted): directs CMS to create and promote a public website consolidating Medicaid eligibility, contact points, LTSS, and HCBS wait-list information for individuals with disabilities and caregivers, improving navigation of existing benefits without changing coverage or payment. (novelty: 3) (novelty: 3)
• 2026-04-30 — Ensuring Seniors’ Access to Quality Care Act: 2025 — Ensuring Seniors’ Access to Quality Care Act (introduced): would relax the Medicaid/Medicare prohibition on nurse-aide training at sanctioned SNFs post-remediation, easing a longstanding workforce restriction on facilities that lost training authority after quality sanctions. (novelty: 2)
• 2025-06-10 — Protecting Health Care for All Patients Act of 2025: 2025 — Protecting Health Care for All Patients Act of 2025 (introduced): would extend the federal QALY prohibition to Medicaid and CHIP coverage/reimbursement determinations, constraining state and federal value-assessment tools that discount life value by disability, age, or terminal illness. (novelty: 3)
• 2026-07-14 — Securing Healthcare and Income Entitlements for Lawfully Domiciled Citizens (SHIELD Citizens) Act: 2026 — SHIELD Citizens Act (HR9667, introduced): would condition federal healthcare entitlements including Medicaid on lawful domicile/citizenship status; referred to Energy and Commerce among other committees, no substantive text yet public. (novelty: 2)
• 2026-07-16 — Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program: 2026 — CY 2027 Physician Fee Schedule Proposed Rule: touches Medicaid indirectly through updates to RHC/FQHC payment methodologies and clinical laboratory fee schedule policies that flow into state Medicaid programs. (novelty: 2) (novelty: 2)
• 2025-12-18 — Debt Solution and Accountability Act: 2025 — Debt Solution and Accountability Act (introduced): would require Treasury reports at debt-limit events to include fiscal-sustainability projections for Medicaid alongside Medicare and Social Security, a transparency mandate that does not change Medicaid eligibility, coverage, or financing directly. (novelty: 2)
• 2025-12-18 — Do No Harm in Medicaid Act: 2025 — Do No Harm in Medicaid Act (HR498, introduced): would prohibit federal Medicaid payment for gender transition procedures for individuals under 18, with exceptions for early puberty treatment with parental consent, genetic/chromosomal disorders, reversal of prior procedures, and prevention of imminent death or major bodily impairment. (novelty: 3)
• 2026-06-24 — MOMMIES Act: 2026-06-24 — MOMMIES Act (S4913, introduced): referred to Senate Finance; maternal health measure within Medicaid/Finance jurisdiction, provisions pending bill text review. (novelty: 2)
• 2026-06-23 — Latonya Reeves Freedom Act of 2026: 2026 — Latonya Reeves Freedom Act of 2026 (HR9401, introduced): would prohibit disability discrimination by requiring access to community-based long-term services and supports (largely delivered through Medicaid HCBS) as an alternative to institutional placement. (novelty: 2)
• 2025-09-18 — Protecting Free Vaccines Act: 2025-09-18 — Protecting Free Vaccines Act (HR5448, introduced): would require Medicaid and CHIP to cover ACIP-recommended vaccines (as of Oct 25, 2024) without cost-sharing through Jan 1, 2030. (novelty: 2) (novelty: 2)
• 2025-05-29 — Menstrual Equity For All Act of 2025: 2025 — Menstrual Equity For All Act of 2025 (introduced): would require state Medicaid programs to cover menstrual products as a mandatory benefit, expanding covered supplies for enrollees. (novelty: 3)
• 2025-03-27 — Ensuring Medicaid Eligibility Act of 2025: 2025 — Ensuring Medicaid Eligibility Act of 2025 (introduced): would require states to verify citizenship/immigration status before enrollment, mandate quarterly income redeterminations, and bar federal Medicaid payments for noncitizens with parole, asylum, TPS, withholding of removal, or DACA status. (novelty: 3) (novelty: 3)
• 2026-05-20 — Veterans Community Care Scheduling Improvement Act: 2026 — Veterans Community Care Scheduling Improvement Act (HR3482, introduced): would extend through June 2033 the $90/month cap on VA pension payments to veterans residing in Medicaid-funded nursing homes, preserving an existing Medicaid-VA benefit coordination limitation. (novelty: 2) (novelty: 2)
• 2025-02-20 — Fatal Overdose Reduction Act of 2025: 2025 — Fatal Overdose Reduction Act of 2025 (introduced): would authorize a five-year Medicaid demonstration providing states at least a 90% federal match for comprehensive opioid and SUD services delivered through certified Health Engagement Hubs. (novelty: 3)
• 2025-02-18 — Poverty Line Act of 2025: 2025 — Poverty Line Act of 2025 (introduced): would restructure HHS federal poverty guideline methodology to reflect regional household expenditures, housing, and health insurance costs, potentially shifting Medicaid income-eligibility thresholds that key off FPL. (novelty: 3)
• 2026-03-26 — Ensuring Medicaid Continuity for Children in Foster Care Act of 2026: 2026 — Ensuring Medicaid Continuity for Children in Foster Care Act of 2026 (HR8095, introduced): would allow states to receive federal Medicaid reimbursement for services provided to foster care children placed in qualified residential treatment programs using trauma-informed models. (novelty: 2)
• 2026-03-19 — Healthy Moms and Babies Act: 2026 — Healthy Moms and Babies Act (introduced): would expand Medicaid and CHIP maternal health services through state-option maternity health homes, a telehealth demonstration for pregnant/postpartum enrollees, a study on doula service coverage, and CMS guidance on social determinants of health for pregnant and postpartum women. (novelty: 3) (novelty: 3)
• 2025-02-24 — PIIA Reform Act: 2026 — PIIA Reform Act (HR1533, introduced): would create an OMB ‘Overpayment Czar’ and penalize noncompliant agencies with appropriations reductions; Medicaid is historically one of the largest sources of reported federal improper payments and would be a primary focus of intensified CMS reporting and remediation obligations. (novelty: 2) (novelty: 2)
• 2025-09-08 — Due Process Continuity of Care Act: 2026 — Due Process Continuity of Care Act (HR1510, introduced): would allow states to optionally provide Medicaid benefits to pretrial detainees and offers state planning grants to support implementation, addressing the longstanding inmate exclusion coverage gap. (novelty: 3) (novelty: 3)
• 2026-06-24 — Medicaid RAC Improvement Act of 2026: 2026 — Medicaid RAC Improvement Act of 2026 (S4898, introduced): referred to Senate Finance; proposes reforms to the Medicaid Recovery Audit Contractor program governing post-payment audits of provider claims. (novelty: 2) (novelty: 2)
• 2026-05-20 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program: 2026 — HHS Final Rule, NBPP 2027: revises Basic Health Program payment calculation methodology; BHP serves individuals 138–200% FPL as a Medicaid/CHIP-adjacent state option and payment changes affect state financing decisions. (novelty: 3) (novelty: 3)
• 2026-05-11 — No-Cost Breast Examinations in Medicaid Act of 2026: 2026 — No-Cost Breast Examinations in Medicaid Act of 2026 (HR8729, introduced): would require state Medicaid programs to cover breast examinations with no cost-sharing to beneficiaries. (novelty: 2)
• 2026-05-22 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments: 2026 — CMS Proposed Rule, Medicaid Managed Care State Directed Payments and Fee-for-Service Targeted Practitioner Payments: would tighten limits on state directed payments in managed care and establish new caps on targeted FFS practitioner payments to enforce actuarial soundness and payment efficiency. (novelty: 2)
• 2026-06-02 — Notice of Vacatur Regarding Certain Provisions of the 2024 Nondiscrimination in Health Programs and Activities Final Rule: cross-connection with aca-section-1557-nondiscrimination: Section 1557 nondiscrimination requirements attach to Medicaid-funded providers and managed care plans. (novelty: 3)
• 2026-06-03 — Medicaid Program; Community Engagement Requirement for Certain Individuals: 2025 — CMS Interim Final Rule, Community Engagement Requirement for Certain Individuals: requires states to condition Medicaid eligibility for certain enrollees on demonstrating community engagement (work, volunteering, or education), with state implementation required by January 1, 2027. (novelty: 3)
• 2025-12-16 — Essential Caregivers Act of 2025: 2025 — Essential Caregivers Act of 2025 (introduced): would prohibit Medicaid-participating nursing and rehabilitation facilities from restricting essential caregiver access to residents, including during emergency periods, allowing limited exceptions up to 14 days with state approval. (novelty: 2)
• 2026-06-18 — Medicaid Equal Standards Act: 2026 — Medicaid Equal Standards Act (HR9345, introduced): referred to House Energy and Commerce; would establish equal standards within the Medicaid program (specifics pending bill text review). (novelty: 2)
• 2026-06-08 — Prior Authorization Reform for Autoimmune and Blood Disorders Act: 2026 — Prior Authorization Reform for Autoimmune and Blood Disorders Act (HR9192, introduced): referred to Energy and Commerce (Medicaid jurisdiction) among other committees; would reform prior authorization requirements for autoimmune and blood disorders. (novelty: 2)
• 2025-02-13 — I CAN Act: 2026 — I CAN Act (introduced): would expand the documentation, supervision, and certification functions that nurse practitioners, physician assistants, and clinical nurse specialists may perform under Medicaid. (novelty: 2)
• 2025-10-03 — Medical Foods and Formulas Access Act of 2025: 2025 — Medical Foods and Formulas Access Act of 2025 (introduced): would require Medicaid and CHIP to cover medically necessary foods, formulas, and associated equipment for individuals with digestive or metabolic disorders. (novelty: 3) (novelty: 3)
• 2026-03-09 — MVP Act: 2026 — MVP Act (introduced): would grant statutory authority for value-based purchasing arrangements under the Medicaid Drug Rebate Program, allowing multiple best price points tied to clinical outcomes. (novelty: 3)
• 2026-07-02 — Revised Medical Criteria for Evaluating Cardiovascular Disorders: cross-connection with ssa-disability-listings: SSI disability determinations under SSA’s listings are a pathway to Medicaid eligibility in most states. (novelty: 2)

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