Medicaid Bump Act
- Bill Number
- H.R. 4745
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-23: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-05-12T08:05:52Z
AI-Generated Summary
Purpose
The Medicaid Bump Act (H.R. 4745) aims to increase federal financial support for state Medicaid programs by providing a higher matching rate for expenditures on behavioral health services. These services include mental health care and substance use treatment, helping states expand access to such care without reducing their own funding levels.
Key Provisions
- Higher Federal Matching Rate: For Medicaid expenditures on behavioral health services that exceed the amounts spent in the four-quarter period ending March 31, 2019, the federal government will cover 90% of the increase (compared to the standard matching rate, which varies by state but is typically lower).
- Accountability Requirements for States:
- States must use the additional federal funds to supplement (add to) existing state spending on these services as of April 1, 2021, rather than supplant (replace) it.
- Funds must support activities that boost the capacity, efficiency, and quality of behavioral health services, such as raising payment rates for providers or measures to lower staff turnover.
- Guidance from the Secretary of Health and Human Services (HHS): Within 180 days of enactment, HHS must issue guidance defining what qualifies as "behavioral health services" under this law.
- Reporting Requirement: Starting one year after enactment and annually thereafter, HHS must report to Congress on behavioral health services under Medicaid, including payment rates, how those rates are determined, and service utilization data (where available).
- Effective Date: Changes apply to calendar quarters starting January 1 of the year following one year after enactment (e.g., if enacted in 2025, effective January 1, 2027).
Significant Changes to Existing Law
This bill amends Section 1903 of the Social Security Act, which governs federal payments to states for Medicaid. It introduces a new 90% federal matching rate specifically for growth in behavioral health spending above a 2019 baseline, along with new state maintenance-of-effort rules and targeted use requirements. Previously, federal matching rates for Medicaid services were uniform and lower (averaging around 60-70% depending on the state), with no special incentive for behavioral health expansions.
Potential Impacts
- On Government Agencies: HHS will face increased administrative duties for guidance issuance and annual reporting, while the federal government may see higher overall Medicaid spending due to the elevated matching rate.
- On Citizens: Low-income individuals eligible for Medicaid could gain better access to mental health and substance use services through expanded provider capacity and higher payments, potentially reducing wait times and improving care quality.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. Medicaid programs.
- Broader Effects: States may invest more in behavioral health infrastructure, but only if they can demonstrate compliance to avoid losing the enhanced funding.
Main Stakeholders Affected
- States and Medicaid Agencies: Primary recipients of the additional federal funds, but required to maintain spending levels and report data.
- Healthcare Providers: Especially those offering behavioral health services (e.g., therapists, counselors, addiction treatment centers), who may benefit from higher reimbursements and reduced staffing challenges.
- Medicaid Enrollees: Particularly those with mental health or substance use needs, who could see improved service availability.
- Federal Government (HHS and Congress): Responsible for oversight, guidance, and monitoring program effectiveness.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: The law adds enforceable conditions to federal Medicaid funding, requiring states to comply with supplement-not-supplant rules; non-compliance could lead to reduced payments, potentially triggering disputes under federal grant laws.
- Constitutional Implications: Aligns with Congress's spending power under the U.S. Constitution (Article I, Section 8), as it uses federal funds to encourage state actions in public health, but includes "strings" on how states use the money, which has been upheld in past Supreme Court cases on conditional spending (e.g., as long as conditions are clear and related to the program's goals).
- Political Implications: Bipartisan introduction (by Reps. Tonko and Fitzpatrick) signals broad support for addressing mental health and substance use crises, potentially influencing future budget negotiations by prioritizing behavioral health within Medicaid expansions.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (3)
Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Thanedar, Shri [D-MI-13], Rep. Stansbury, Melanie A. [D-NM-1]
Recent Actions
- 2025-07-23: Referred to the House Committee on Energy and Commerce.
- 2025-07-23: Introduced in House
- 2025-07-23: Introduced in House
Bill Versions
- Medicaid Bump Act — issued 2025-07-23 — PDF (5 pages)