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Title II — Putting American patients first

S. 3386 · 119th Congress · Dec 8, 2025 · Lineage

II Putting American patients first

Sec. 201 Expansion FMAP for certain States providing payments for health care furnished to certain individuals

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(1)
in subsection (y)—
(A)
in paragraph (1)(E), by inserting “(or, for calendar quarters beginning on or after October 1, 2027, in the case such State is a specified State with respect to such calendar quarter, 80 percent)” after “thereafter”; and
(B)
in paragraph (2), by adding at the end the following new subparagraph:

“(C) Specified State—The term “specified State” means, with respect to a quarter, a State that—

“(i) provides any form of financial assistance from a State general fund during such quarter, in whole or in part, whether or not made under a State plan (or waiver of such plan) under this title or under another program established by the State, to or on behalf of an alien who is not a qualified alien and is not a child or pregnant woman who is lawfully residing in the United States and eligible for medical assistance pursuant to section 1903(v)(4) or for child health assistance or pregnancy-related assistance pursuant to section 2107(e)(1)(Q), for the purchasing of health insurance coverage (as defined in section 2791(b)(1) of the Public Health Service Act) for an alien who is not a qualified alien and is not such a child or pregnant woman; or

“(ii) provides any form of comprehensive health benefits coverage, except such coverage required by Federal law, during such quarter, whether or not under a State plan (or waiver of such plan) under this title or under another program established by the State, and regardless of the source of funding for such coverage, to an alien who is not a qualified alien and is not such a child or pregnant woman.

“(D) Immigration terms

“(i) Alien—The term “alien” has the meaning given such term in section 101(a) of the Immigration and Nationality Act.

“(ii) Qualified alien—The term “qualified alien” has the meaning given such term in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, except that the references to “(in the opinion of the agency providing such benefits)” in subsection (c) of such section 431 shall be treated as references to “(in the opinion of the State in which such comprehensive health benefits coverage or such financial assistance is provided, as applicable)”.”

(2)
in subsection (z)(2)—
(A)
in subparagraph (A), by striking “for such year” and inserting “for such quarter”; and
(B)
in subparagraph (B)(i)—
(i)
in the matter preceding subclause (I), by striking “for a year” and inserting “for a calendar quarter in a year”; and
(ii)
in subclause (II), by striking “for the year” and inserting “for the quarter for the State”.

Sec. 202 Prohibiting Federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality, or satisfactory immigration status

(a)
In general—
(1)
Medicaid— Section 1903(i)(22) of the Social Security Act (42 U.S.C. 1396b(i)(22)) is amended—
(A)
by adding “and” at the end;
(B)
by striking “to amounts” and inserting "to—

“(A) amounts”

(C)
by adding at the end the following new subparagraph:

“(B) in the case that the State elects under section 1902(a)(46)(C) to provide for making medical assistance available to an individual during—

“(i) the period in which the individual is provided the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality under section 1902(ee)(2)(C) or subsection (x)(4);

“(ii) the 90-day period described in section 1902(ee)(1)(B)(ii)(II); or

“(iii) the period in which the individual is provided the reasonable opportunity to submit evidence indicating a satisfactory immigration status under section 1137(d)(4),”

(2)
CHIP— Section 2107(e)(1)(O) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(O)) is amended by striking “and (17)” and inserting “(17), and (22)”.
(b)
Eliminating State requirement to provide medical assistance during reasonable opportunity period—
(1)
Documentary evidence of citizenship or nationality— Section 1903(x)(4) of the Social Security Act (42 U.S.C. 1396b(x)) is amended—
(A)
by striking “under clauses (i) and (ii) of section 1137(d)(4)(A)” and inserting “under section 1137(d)(4)”; and
(B)
by inserting “, except that the State shall not be required to make medical assistance available to such individual during the period in which such individual is provided such reasonable opportunity if the State has not elected the option under section 1902(a)(46)(C)” before the period at the end.
(2)
Social Security data match— Section 1902(ee) of the Social Security Act (42 U.S.C. 1396a(ee)) is amended—
(A)
in paragraph (1)(B)(ii)—
(i)
in subclause (II), by striking “(and continues to provide the individual with medical assistance during such 90-day period)” and inserting “and, if the State has elected the option under subsection (a)(46)(C), continues to provide the individual with medical assistance during such 90-day period”; and
(ii)
in subclause (III), by inserting “, or denies eligibility for medical assistance under this title for such individual, as applicable” after “under this title”; and
(B)
in paragraph (2)(C)—
(i)
by striking “under clauses (i) and (ii) of section 1137(d)(4)(A)” and inserting “under section 1137(d)(4)”; and
(ii)
by inserting “, except that the State shall not be required to make medical assistance available to such individual during the period in which such individual is provided such reasonable opportunity if the State has not elected the option under section 1902(a)(46)(C)” before the period at the end.
(3)
Individuals with satisfactory immigration status— Section 1137(d)(4) of the Social Security Act (42 U.S.C. 1320b–7(d)(4)) is amended—
(A)
in subparagraph (A)(ii), by inserting “(except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C))” after “has been provided”; and
(B)
in subparagraph (B)(ii), by inserting “(except that such prohibition on delay, denial, reduction, or termination of eligibility for benefits under the Medicaid program under title XIX shall apply only if the State has elected the option under section 1902(a)(46)(C))” after “status”.
(c)
Option to continue providing medical assistance during reasonable opportunity period—
(1)
Medicaid— Section 1902(a)(46) of the Social Security Act (42 U.S.C. 1396a(a)(46)) is amended—
(A)
in subparagraph (A), by striking “and” at the end;
(B)
in subparagraph (B)(ii), by adding “and” at the end; and
(C)
by inserting after subparagraph (B)(ii) the following new subparagraph:

“(C) provide, at the option of the State, for making medical assistance available—

“(i) to an individual described in subparagraph (B) during the period in which such individual is provided the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality under subsection (ee)(2)(C) or section 1903(x)(4), or during the 90-day period described in subsection (ee)(1)(B)(ii)(II); or

“(ii) to an individual who is not a citizen or national of the United States during the period in which such individual is provided the reasonable opportunity to submit evidence indicating a satisfactory immigration status under section 1137(d)(4);”

(2)
CHIP— Section 2105(c)(9) of the Social Security Act (42 U.S.C. 1397ee(c)(9)) is amended by adding at the end the following new subparagraph:

“(C) Option to continue providing child health assistance during reasonable opportunity period—Section 1902(a)(46)(C) shall apply to States under this title in the same manner as it applies to a State under title XIX.”

(d)
Effective date— The amendments made by this section shall apply beginning on October 1, 2026.