Medicaid Staffing Flexibility and Protection Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6254 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 6254

  To amend title XIX of the Social Security Act to allow States more 
   flexibility with respect to using contractors to make eligibility 
determinations and redeterminations and conduct fair hearings on behalf 
          of the State Medicaid plan, and for other purposes.


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                    IN THE HOUSE OF REPRESENTATIVES

                           November 21, 2025

 Mr. Carter of Georgia (for himself, Mr. Davis of North Carolina, Mr. 
 Dunn of Florida, Mr. Bacon, and Mr. Valadao) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

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                                 A BILL


 
  To amend title XIX of the Social Security Act to allow States more 
   flexibility with respect to using contractors to make eligibility 
determinations and redeterminations and conduct fair hearings on behalf 
          of the State Medicaid plan, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Staffing Flexibility and 
Protection Act of 2025''.

SEC. 2. STATE FLEXIBILITY TO USE CONTRACTORS TO MAKE ELIGIBILITY 
              DETERMINATIONS, REDETERMINATIONS, AND FAIR HEARINGS ON 
              BEHALF OF A STATE.

    (a) Requirements With Respect to Eligibility Determinations.--
Section 1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)) 
is amended by inserting before the semicolon at the end the following: 
``, but such determinations of eligibility may be made, at the option 
of a State, under a contract with another State or local agency or a 
contractor, so long as the contract does not provide incentives for the 
agency or contractor to delay eligibility determinations or to deny 
eligibility for individuals otherwise eligible for medical 
assistance''.
    (b) Requirements With Respect to Fair Hearings.--Section 1902(a)(3) 
of the Social Security Act (42 U.S.C. 1396a(a)(3)) is amended by 
inserting before the semicolon at the end the following: ``, except 
that such fair hearing may be conducted, at the option of a State, 
under a contract with another State or local agency or a contractor, so 
long as such agency or contractor does not provide incentives to delay 
a fair hearing or to deny eligibility for an individual otherwise 
eligible for medical assistance''.

SEC. 3. PROHIBITING CONFLICTS OF INTEREST.

    A State shall not use the flexibility provided under section 2 
unless a contractor selected to conduct eligibility determinations or 
redeterminations pursuant to the amendments made by such section has no 
direct or indirect financial relationship with any Medicaid managed 
care organization (as defined in section 1903(m)(1)(A) of the Social 
Security Act (42 U.S.C. 1396b(m)(1)(A))), including the network 
providers affiliated with such organization, that provides services to 
individuals entitled to medical assistance under title XIX of such Act 
(42 U.S.C. 1396 et seq.) pursuant to a contract with such State.
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