Combating Deceptive Practices in Assistance Programs Act of 2026
Summary
What This Bill Does
The Combating Deceptive Practices in Assistance Programs Act changes the federal Medicaid definition of personal care services. Beginning January 12, 2027, Medicaid assistance for those services is limited to an individual who is unable to perform three or more activities of daily living as defined in the Internal Revenue Code.
The referenced activities generally concern core self-care functions. The amendment creates a numerical functional-impairment threshold within the personal-care-services category; the bill does not establish an alternative eligibility pathway, a transition rule for current recipients, or an exception based solely on diagnosis, age, income, caregiver availability, or risk of institutionalization.
The bill applies to medical assistance furnished on or after the effective date. It does not retroactively recoup payment for earlier services and does not by its text change eligibility for other Medicaid benefit categories.
Who Benefits and How
State Medicaid programs and federal Medicaid accounts may reduce spending by excluding personal-care claims for individuals below the three-activity threshold. Taxpayers may bear lower program cost. Beneficiaries with at least three qualifying limitations may receive a more clearly defined federal eligibility rule and could benefit if limited resources are concentrated on people with higher measured need.
Who Bears the Burden and How
Current or prospective recipients unable to perform only one or two activities may lose Medicaid-funded personal care after January 12, 2027. Their families may absorb unpaid caregiving or private-service costs, and some individuals may face greater institutionalization or health risk. Home-care agencies and personal-care workers may lose service volume. State Medicaid staff must reassess functional limitations, update systems and notices, and handle appeals.
Key Provisions
- Tightens Medicaid personal-care eligibility to a three-activity threshold.
- Uses the existing tax-code definition of activities of daily living.
- Requires the individual to be unable to perform at least three activities.
- Applies to medical assistance furnished on or after January 12, 2027.
- Provides no diagnosis-only or caregiver-availability exception.
- Provides no express grandfather rule for existing recipients.
- Limits the change to the personal-care-services category.
- Protects payments for services furnished before the effective date from retroactive application.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Restricts Medicaid personal care services furnished on or after January 12, 2027 to individuals who are unable to perform at least three statutory activities of daily living.
Key Policy Areas
Medicaid Personal Care Services, Activities of Daily Living, Home and Community-Based Care, Disability Services, Medicaid Eligibility
Primary Purpose
Restricts Medicaid personal care services furnished on or after January 12, 2027 to individuals who are unable to perform at least three statutory activities of daily living.
Policy Domains
Section 2 Medicaid personal-care functional threshold
Identified Gains
- State Medicaid programs reducing personal-care claims
- Federal Medicaid accounts reducing matching payments
- Taxpayers funding Medicaid personal care
- Beneficiaries meeting the three-activity threshold
- High-need recipients competing for care capacity
- Eligibility reviewers applying a numerical standard
Identified Costs
- Recipients with one activity limitation
- Recipients with two activity limitations
- Families replacing lost personal care
- Home-care agencies losing Medicaid service volume
- Personal-care workers losing paid hours
- State Medicaid functional-assessment staff
- Beneficiaries appealing adverse determinations
Legislative Progress
In CommitteeReferred to the House Committee on Energy and Commerce.
Introduced in House
Mr. Schweikert introduced the following bill; which was referred to …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Beneficiaries appealing adverse determinations, Beneficiaries meeting the three-activity threshold, High-need recipients competing for care capacity
Positive-direction: Beneficiaries meeting the three-activity threshold, High-need recipients competing for care capacity
Negative-direction: Beneficiaries appealing adverse determinations, Recipients with one activity limitation, Recipients with two activity limitations
Eligibility reviewers applying a numerical standard, State Medicaid functional-assessment staff, State Medicaid programs reducing personal-care claims
Positive-direction: Eligibility reviewers applying a numerical standard, State Medicaid programs reducing personal-care claims
Negative-direction: State Medicaid functional-assessment staff
Home-care agencies losing Medicaid service volume, Personal-care workers losing paid hours
Federal Medicaid accounts reducing matching payments
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "provider"
- → Personal care services provider
- "applicant"
- → Medicaid beneficiary seeking personal care services
- "caregiver"
- → Family caregiver supporting an affected beneficiary
- "administrator"
- → State Medicaid agency
- "federal_overseer"
- → Centers for Medicare and Medicaid Services
Note: {'scope_ids': ['medicaid_personal_care_adl_threshold'], 'description': 'The restriction applies prospectively to Medicaid personal care services, not every Medicaid benefit, and the bill provides no express grandfather rule or alternative pathway for a person below the three-activity threshold.'}
Key Definitions
Terms defined in this bill
Medical assistance furnished on or after January 12, 2027.
Inability to perform at least three activities of daily living under the referenced Internal Revenue Code definition.
The Medicaid benefit category in section 1905(a)(24), as narrowed by the new functional threshold.
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