HR2445-119

What This Bill Does

The Ensuring Medicaid Eligibility Act tightens Medicaid eligibility verification and immigration-related payment rules. State Medicaid plans and waivers could not enroll an individual before verifying that the person is a U.S. citizen, national, or in satisfactory immigration status. For people whose eligibility depends in part on income under modified adjusted gross income rules, states must verify eligibility at least quarterly. The bill also amends section 1903(v) to deny federal Medicaid payment for medical assistance furnished to aliens granted parole, deferred action or deferred enforced departure including DACA, asylum, temporary protected status, or withholding of removal, subject to existing emergency and related exceptions. It also prevents those groups from being treated as permanently residing under color of law for Medicaid purposes.

Who Benefits and How

Federal taxpayers benefit if federal Medicaid payments are withheld for immigration categories the bill makes ineligible for federal matching funds. State Medicaid program integrity units benefit from clearer pre-enrollment status verification and quarterly income checks. Restriction-focused immigration policy advocates benefit from limiting Medicaid coverage for parolees, DACA recipients, asylees, TPS recipients, and withholding recipients. Medicaid eligibility auditors benefit from more frequent verification records.

Who Bears the Burden and How

State Medicaid agencies must verify citizenship or satisfactory immigration status before enrollment and check income-based eligibility quarterly. Parolees receiving Medicaid may lose federally matched medical assistance outside emergency or specified exceptions. DACA recipients and deferred action recipients may lose federally matched Medicaid coverage. Asylees, TPS recipients, and withholding recipients may lose federally matched Medicaid coverage under the new payment bar. CMS Medicaid staff must update state plan, waiver, and federal matching payment guidance.

Key Provisions

• Prohibits Medicaid enrollment before state verification of U.S. citizenship, nationality, or satisfactory immigration status.
• Requires quarterly verification for Medicaid beneficiaries whose eligibility is based partly on income.
• Bars federal Medicaid payment for medical assistance furnished to parolees, deferred action recipients, asylees, TPS recipients, and withholding recipients.
• Applies notwithstanding PRWORA eligibility provisions and other Medicaid title provisions, subject to emergency and specified exceptions.
• Prevents covered aliens from being treated as permanently residing under color of law for Medicaid eligibility.