MEDICAID-What the Big Beautiful Bill Says

(Disclaimer: If you're here to be mad that the cuts you believe will happen aren't listed, make sure to read the entire thing for yourself. I only tried to make it easier to understand. Feel free to empower yourself.)

You likely don't want to have to read and understand the Big Beautiful Bill in its entirety so I pulled out the most talked about section to break it down. I will write the interpretation in italics following the paragraph or section.

Here we go...

Subtitle D--Health

Part 1--Medicaid

Subpart A--Reducing Fraud and Improving Enrollment Processes

(Sec. 44103) This section requires the Centers for Medicare & Medicaid Services (CMS) to establish a centralized system for states to check whether enrollees are simultaneously enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states. 

They're checking to make sure people aren't double dipping and collecting these services from multiple states.

Beginning no later than 2027, states must regularly obtain the addresses of Medicaid and CHIP enrollees from specified authorized sources. Beginning no later than FY2030, states must report on at least a monthly basis the Social Security numbers of enrollees to the CMS' newly established system. The CMS must notify states on at least a monthly basis of individuals who are enrolled in multiple states so that states may take appropriate action. 

The section provides funds for FY2026 and FY2029 for the CMS to establish and maintain the new system, respectively.

It will be reported if folks are trying to take from more than one state, that's pretty fair to a reasonable person and likely is done to take sure there's enough for everyone who needs it.

(Sec. 44104) This section requires state Medicaid programs to check, beginning in 2028, the Social Security Administration's Death Master File on at least a quarterly basis to determine whether Medicaid enrollees are deceased.

This is a measure to make sure that someone who has died isn't still collecting benefits.

(Sec. 44105) This section requires state Medicaid programs to check, beginning in 2028, as part of the provider enrollment and reenrollment process, whether providers were terminated from participating in the Medicare program, any other state Medicaid program, or CHIP using certain databases (e.g., the Data EXchange system). The section requires states to continue to check these databases on at least a monthly basis after providers are enrolled.

If a doctor, or health care facility has been dropped from the Medicare and Medicaid program or the CHIP program, the state needs to know about it. Being dropped doesn't mean you can continue to bill under that program and collect money.

(Sec. 44106) This section provides statutory authority for the requirement that state Medicaid programs check, as part of the provider enrollment and reenrollment process, whether providers are deceased through the Social Security Administration's Death Master File. Beginning in 2028, the section requires states to continue to check this database on at least a quarterly basis after providers are enrolled.

Are the doctors dead? If they're still billing for Medicaid programs, they want to know about it. Probably shouldn't be.

(Sec. 44108) This section requires state Medicaid programs to redetermine every six months, beginning on December 31, 2026, the eligibility of individuals who are enrolled in Medicaid as part of the Medicaid expansion population under the Patient Protection and Affordable Care Act. (The act allows states to extend Medicaid coverage to all adults under the age of 65 with incomes of up to 138% of the federal poverty level, including able-bodied adults without dependent children.)

States will have to check and see if those getting the benefits are still eligible to get them, Circumstances change. This will be done every six months.

(Sec. 44111) This section reduces by 10%, beginning in FY2028, the enhanced federal matching rate for the Medicaid expansion population in states that provide comprehensive health benefits or financial assistance for purchasing health benefits to individuals (other than children or pregnant women) who are not lawfully residing in the United States, regardless of the source of the benefits or financial assistance.

Benefits will be reduced in states that provide health benefits to people who are here illegally. It will not pertain to pregnant women and children, however.

AND you may read all of it for yourself, here https://www.congress.gov/bill/119th-congress/house-bill/1/text