To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program.

This bill establishes community engagement requirements (i.e., work requirements) for certain adults under Medicaid.

Specifically, the bill requires individuals ages 18 through 65 to work, engage in community service, or participate in a work program (or a combination of these) for at least 80 hours per month. The bill prohibits federal payments for, and allows state Medicaid programs to disenroll, individuals who do not meet these requirements for three or more months in a year.

The requirements do not apply to individuals who are (1) physically or mentally unfit to work, (2) pregnant, (3) parents or caretakers of children or incapacitated individuals, (4) complying with work requirements for other federal programs, (5) participating in a drug or alcohol treatment and rehabilitation program, or (6) enrolled at least half-time in school.

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1279 Introduced in House (IH)]

<DOC>






119th CONGRESS
  1st Session
                                H. R. 1279

To amend title XIX of the Social Security Act to establish a community 
   engagement requirement for certain individuals under the Medicaid 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2025

 Mr. Bean of Florida (for himself, Mr. Weber of Texas, Mr. Kennedy of 
Utah, and Mr. Scott Franklin of Florida) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to establish a community 
   engagement requirement for certain individuals under the Medicaid 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. COMMUNITY ENGAGEMENT REQUIREMENT FOR APPLICABLE INDIVIDUALS.

    (a) In General.--Section 1903(i) of the Social Security Act (42 
U.S.C. 1396b(i)) is amended--
            (1) in paragraph (26), by striking ``; or'' and inserting a 
        semicolon;
            (2) in paragraph (27), by striking the period at the end 
        and inserting ``; or'';
            (3) by inserting after paragraph (27) the following new 
        paragraph:
            ``(28) with respect to any amount expended for medical 
        assistance for an applicable individual for a month in a 
        calendar year if such individual did not meet the community 
        engagement requirement under section 1905(kk) for 3 or more 
        preceding months during such calendar year while such 
        individual was an applicable individual and was enrolled in a 
        State plan (or waiver of such plan) under this title.''; and
            (4) in the flush left matter at the end, by striking ``and 
        (18),'' and inserting ``(18), and (28)''.
    (b) Community Engagement Requirement.--Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended by adding at the end the 
following new subsection:
    ``(kk) Community Engagement Requirement for Applicable 
Individuals.--
            ``(1) Community engagement requirement described.--For 
        purposes of section 1903(i)(28), the community engagement 
        requirement described in this subsection with respect to an 
        applicable individual and a month is that such individual 
        satisfies at least one of the following with respect to such 
        month:
                    ``(A) The individual works 80 hours or more per 
                month, or has a monthly income that is at least equal 
                to the Federal minimum wage under section 6 of the Fair 
                Labor Standards Act of 1938, multiplied by 80 hours.
                    ``(B) The individual completes 80 hours or more of 
                community service per month.
                    ``(C) The individual participates in a work program 
                for at least 80 hours per month.
                    ``(D) The individual participates in a combination 
                of work, including community service, and a work 
                program for a total of at least 80 hours per month.
            ``(2) Verification.--For purposes of verifying the 
        compliance of an applicable individual with the community 
        engagement requirement under paragraph (1), a State Medicaid 
        agency shall, whenever possible, prioritize the utilization of 
        existing databases or other verification measures, including 
        the National Change of Address Database Maintained by the 
        United States Postal Service, State health and human services 
        agencies, payroll databases, or other reliable sources of 
        information, prior to seeking additional verification from such 
        individual.
            ``(3) Definitions.--In this subsection:
                    ``(A) Applicable individual.--The term `applicable 
                individual' means any individual who is not--
                            ``(i) under 18 years of age or over 65 
                        years of age;
                            ``(ii) physically or mentally unfit for 
                        employment, as determined by a physician or 
                        other medical professional;
                            ``(iii) pregnant;
                            ``(iv) the parent or caretaker of a 
                        dependent child;
                            ``(v) the parent or caretaker of an 
                        incapacitated person;
                            ``(vi) complying with work requirements 
                        under a different program under Federal law;
                            ``(vii) participating in a drug or alcohol 
                        treatment and rehabilitation program (as 
                        defined in section 3(h) of the Food and 
                        Nutrition Act of 2008); or
                            ``(viii) enrolled in an educational program 
                        at least half time.
                    ``(B) Educational program.--The term `educational 
                program' means--
                            ``(i) an institution of higher education 
                        (as defined in section 101(a) of the Higher 
                        Education Act of 1965);
                            ``(ii) a program of career and technical 
                        education (as defined in section 3 of the Carl 
                        D. Perkins Career and Technical Education Act 
                        of 2006); or
                            ``(iii) any other educational program 
                        approved by the Secretary.
                    ``(C) State medicaid agency.--The term `State 
                Medicaid agency' means the State agency responsible for 
                administering the State Medicaid plan.
                    ``(D) Work program.--The term `work program' has 
                the meaning given such term in section 6(o)(1) of the 
                Food and Nutrition Act of 2008.''.
    (c) State Option To Disenroll Certain Individuals.--Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)) is amended by adding at 
the end of the flush left text following paragraph (87) the following: 
``Notwithstanding any of the preceding provisions of this subsection, 
at the option of a State, such State may elect to disenroll an 
applicable individual for a month if, with respect to medical 
assistance furnished to such individual for such month, no Federal 
financial participation would be available, pursuant to section 
1903(i)(28).''.
                                 <all>