Bill · H.R. 497· House(119-HR-497)
Medicaid Third Party Liability Act
- Introduced
- 1/16/2025
- Last activity
- 1/16/2025 — Referred to the House Committee on Energy and Commerce.
- Sponsored by
- Dan Crenshaw
- Cosponsors
- None
- Introduced
- In Committee
What this bill would do
The Medicaid Third Party Liability Act aims to amend title XIX of the Social Security Act. This bill seeks to provide clarification regarding the liability of third party payers for medical assistance paid under the Medicaid program. It modifies how states interact with health insurers when providing medical assistance through contracts. The legislation also aims to increase state flexibility regarding the acceptance of rights of recovery and assignments. Additionally, the bill introduces new requirements for verifying an individual's insurance status. These changes are set to take effect on various dates, including January 1, 2026.
Yes
Does this leave more decisions to the states?+4
The bill increases state flexibility regarding the acceptance of rights of recovery and assignment of payments from third parties.
Does this reduce what the federal government spends?+3
The bill introduces penalties that make federal funds unavailable for medical assistance if insurance status is not verified, which may reduce federal outlays.
The opposite
Does this put more money into Medicaid, the health coverage for people on low incomes?-2
The threat of unavailable federal funds due to new verification requirements could negatively impact Medicaid funding levels.
Does this make health care easier to get in general?-2
New requirements to verify third-party insurance coverage could create administrative barriers to accessing Medicaid services.
Would households on low incomes be better off under this?-2
New insurance verification mandates could complicate access to medical assistance for low-income individuals.
Who it would affect, and how
Potential Positive Impacts for People
-
Increased State Flexibility: The bill amends the Social Security Act to allow states to accept a State's right of recovery and the assignment of rights to payment from a responsible third party for items or services (Section 2(c)).
-
Clarification of Insurance Contracts: For states providing medical assistance through a contract with a health insurer, the bill requires contracts to specify if the State is delegating its right of recovery or transferring the assignment of rights to the insurer (Section 2(b)).
Potential Negative Impacts for People
-
New Insurance Verification Requirements: The bill amends the Social Security Act to include the collection of information regarding whether an individual has health insurance coverage provided through a third party and the specific plan they are enrolled in (Section 2(d)(1)).
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Financial Consequences for Unverified Insurance Status: Federal funds may be unavailable for amounts expended after January 1, 2026, for medical assistance for individuals where the State has not obtained and verified their third-party insurance coverage and plan information (Section 2(d)(2)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Governance And Ideology
- Increase States Rights+4
- Healthcare
- Improves Healthcare Access-2Increases Medicaid Funding-2
- Economy And Finance
- Reduces Government Spending+3
- Demographic And Interest Groups
- Good For Low Income Households-2
- 1/16/2025
- Referred to the House Committee on Energy and Commerce.
- Introduced in House