US Codex
Bill
Notes

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

H.R. 1279 · 119th Congress · Feb 13, 2025 · Lineage

A BILL

Section 1 Community engagement requirement for applicable individuals

(a)
In general— Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—
(1)
in paragraph (26), by striking “; or” and inserting a semicolon;
(2)
in paragraph (27), by striking the period at the end and inserting “; or”;
(3)
by inserting after paragraph (27) the following new paragraph:

“(28) with respect to any amount expended for medical assistance for an applicable individual for a month in a calendar year if such individual did not meet the community engagement requirement under section 1905(kk) for 3 or more preceding months during such calendar year while such individual was an applicable individual and was enrolled in a State plan (or waiver of such plan) under this title.”

(4)
in the flush left matter at the end, by striking “and (18),” and inserting “(18), and (28)”.
(b)
Community engagement requirement— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following new subsection:

“(kk) Community engagement requirement for applicable individuals

“(1) Community engagement requirement described—For purposes of section 1903(i)(28), the community engagement requirement described in this subsection with respect to an applicable individual and a month is that such individual satisfies at least one of the following with respect to such month:

“(A) The individual works 80 hours or more per month, or has a monthly income that is at least equal to the Federal minimum wage under section 6 of the Fair Labor Standards Act of 1938, multiplied by 80 hours.

“(B) The individual completes 80 hours or more of community service per month.

“(C) The individual participates in a work program for at least 80 hours per month.

“(D) The individual participates in a combination of work, including community service, and a work program for a total of at least 80 hours per month.

“(2) Verification—For purposes of verifying the compliance of an applicable individual with the community engagement requirement under paragraph (1), a State Medicaid agency shall, whenever possible, prioritize the utilization of existing databases or other verification measures, including the National Change of Address Database Maintained by the United States Postal Service, State health and human services agencies, payroll databases, or other reliable sources of information, prior to seeking additional verification from such individual.

“(3) Definitions—In this subsection:

“(A) Applicable individual—The term applicable individual means any individual who is not—

“(i) under 18 years of age or over 65 years of age;

“(ii) physically or mentally unfit for employment, as determined by a physician or other medical professional;

“(iii) pregnant;

“(iv) the parent or caretaker of a dependent child;

“(v) the parent or caretaker of an incapacitated person;

“(vi) complying with work requirements under a different program under Federal law;

“(vii) participating in a drug or alcohol treatment and rehabilitation program (as defined in section 3(h) of the Food and Nutrition Act of 2008); or

“(viii) enrolled in an educational program at least half time.

“(B) Educational program—The term educational program means—

“(i) an institution of higher education (as defined in section 101(a) of the Higher Education Act of 1965);

“(ii) a program of career and technical education (as defined in section 3 of the Carl D. Perkins Career and Technical Education Act of 2006); or

“(iii) any other educational program approved by the Secretary.

“(C) State medicaid agency—The term State Medicaid agency means the State agency responsible for administering the State Medicaid plan.

“(D) Work program—The term work program has the meaning given such term in section 6(o)(1) of the Food and Nutrition Act of 2008.”

(c)
State option To disenroll certain individuals— Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended by adding at the end of the flush left text following paragraph (87) the following: “Notwithstanding any of the preceding provisions of this subsection, at the option of a State, such State may elect to disenroll an applicable individual for a month if, with respect to medical assistance furnished to such individual for such month, no Federal financial participation would be available, pursuant to section 1903(i)(28).”.