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.
Summary
What This Bill Does
Lets states rely on contractors for Medicaid eligibility and hearing functions only if those contractors have no financial ties to Medicaid managed care organizations or affiliated providers.
Who Benefits and How
Medicaid applicants may benefit from a conflict-of-interest guardrail when states outsource eligibility and hearing functions.
Who Bears the Burden and How
States and contractors must screen for disqualifying financial relationships before using the outsourcing flexibility.
Key Provisions
- Allows contractor use for Medicaid eligibility and hearing functions under prior sections of the bill.
- Bars states from using that flexibility with contractors tied to Medicaid managed care organizations or affiliated providers.
- Creates a conflict-of-interest condition on outsourced eligibility work.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Lets states rely on contractors for Medicaid eligibility and hearing functions only if those contractors have no financial ties to Medicaid managed care organizations or affiliated providers.
Key Policy Areas
Healthcare, Government Operations
Primary Purpose
Lets states rely on contractors for Medicaid eligibility and hearing functions only if those contractors have no financial ties to Medicaid managed care organizations or affiliated providers.
Policy Domains
Main Provisions
Identified Gains
Contextual inference, no direct clause citation- Medicaid applicants and beneficiaries affected by outsourced determinations
- States seeking contractor flexibility without overt conflicts
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Contractors with financial ties to Medicaid managed care organizations or providers
- State Medicaid agencies performing additional conflict screening
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Carter of Georgia (for himself, Mr. Davis of North …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Conflicted Medicaid eligibility contractors
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology