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

Bill Number

H.R. 1279

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-02-13: Referred to the House Committee on Energy and Commerce.

Last Updated

2025-07-07T15:03:40Z

AI-Generated Summary

Purpose

This bill, H.R. 1279, aims to promote self-sufficiency among certain Medicaid recipients by requiring them to engage in work, community service, or related activities to maintain eligibility for federal funding of their medical assistance. It introduces a "community engagement requirement" to encourage participation in productive activities while providing exemptions for vulnerable groups.

Key Provisions

• Community Engagement Requirement: Applicable individuals (non-exempt Medicaid enrollees) must meet at least one of the following each month to qualify for federal Medicaid funding:
• Work 80 hours or more per month, or earn income equivalent to the federal minimum wage multiplied by 80 hours.
• Complete 80 hours or more of community service.
• Participate in a work program (as defined under federal food assistance laws) for at least 80 hours.
• Combine work, community service, and/or work programs to total at least 80 hours.
• Non-Compliance Penalty: Federal funding is withheld for medical assistance provided to an applicable individual in a given month if they failed to meet the requirement for three or more preceding months in the calendar year while enrolled in Medicaid.
• Verification Process: States must prioritize using existing databases (e.g., payroll records, address databases, or state health agency data) to check compliance before requiring individuals to provide additional proof.
• Exemptions for Applicable Individuals: The requirement does not apply to:
• People under 18 or over 65 years old.
• Those physically or mentally unfit for work (as certified by a doctor).
• Pregnant individuals.
• Parents or caretakers of dependent children or incapacitated persons.
• People meeting work requirements in other federal programs.
• Participants in drug or alcohol treatment programs.
• Those enrolled at least half-time in an educational program (e.g., college, vocational training, or other approved programs).
• State Disenrollment Option: States may choose to remove non-compliant applicable individuals from Medicaid coverage in months where federal funding is unavailable due to the requirement.

Significant Changes to Existing Law

• Amends Section 1903(i) of the Social Security Act to add a new condition (paragraph 28) denying federal financial participation for non-compliant individuals, building on existing limits like those for other ineligible groups.
• Adds a new subsection (kk) to Section 1905, defining the community engagement requirement, verification methods, and key terms (e.g., "applicable individual," "work program," "educational program").
• Modifies Section 1902(a) to allow states the option to disenroll individuals when federal funding is withheld, which was not previously available under Medicaid rules.

These changes expand work-related conditions for Medicaid eligibility, similar to those in some food assistance programs, but tailored specifically to Medicaid.

Potential Impacts

• On Government Agencies: State Medicaid agencies will face increased administrative burdens for verification and tracking compliance, potentially raising costs (though using existing databases may mitigate this). The federal government (via the Centers for Medicare & Medicaid Services) could see reduced spending on Medicaid if fewer people qualify, but may need to provide guidance on implementation.
• On Citizens: Applicable Medicaid enrollees (primarily able-bodied adults without dependents, aged 18-65) risk losing coverage after three months of non-compliance, which could limit access to healthcare and increase financial strain. Exempt groups are protected, but others may need to seek jobs, volunteer, or enroll in programs to retain benefits.
• On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. welfare programs.

Main Stakeholders Affected

• Medicaid Enrollees: Especially working-age adults without exemptions, who must comply to avoid coverage loss.
• State Medicaid Agencies: Responsible for implementing verification, exemptions, and potential disenrollments, affecting program administration in all states.
• Federal Government: Through the Department of Health and Human Services, which oversees Medicaid funding and may need to approve state plans or waivers.
• Community Organizations and Employers: Could see increased involvement if more people seek community service or work programs to meet the 80-hour threshold.
• Healthcare Providers: May experience changes in patient enrollment and billing if disenrollments occur.

Notable Legal, Constitutional, or Political Implications

• Legal: The bill aligns with existing federal frameworks for work requirements in programs like SNAP (food stamps) by referencing those definitions, reducing potential legal challenges on consistency. However, it could face lawsuits over administrative feasibility or barriers to healthcare access, similar to past court rulings striking down state work requirements (e.g., on due process or undue burdens).
• Constitutional: No overt conflicts with the Constitution, as Medicaid is a federal-state partnership allowing such conditions. It preserves exemptions to avoid discriminating against protected groups (e.g., disabled or pregnant individuals under equal protection principles).
• Political: Promotes policies emphasizing personal responsibility and reducing welfare dependency, which may appeal to fiscal conservatives but draw criticism from advocates for potentially harming low-income health access. Implementation would require states to amend their Medicaid plans, possibly leading to varied adoption across politically diverse regions.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Bean, Aaron [R-FL-4]

Cosponsors (4)

Rep. Weber, Randy K. Sr. [R-TX-14], Rep. Kennedy, Mike [R-UT-3], Rep. Franklin, Scott [R-FL-18], Rep. Hageman, Harriet M. [R-WY-At Large]

Recent Actions

• 2025-02-13: Referred to the House Committee on Energy and Commerce.
• 2025-02-13: Introduced in House
• 2025-02-13: Introduced in House

Bill Versions

• To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program. — issued 2025-02-13 — PDF (6 pages)