Bill > HR497

This bill modifies the Medicaid third party liability rules to improve how states handle medical insurance recovery and verification processes. Specifically, the bill requires states to clarify their contracts with health insurers (including group health plans, self-insured plans, managed care organizations, and pharmacy benefit managers) by specifying whether the state is delegating its right to recover costs from responsible third parties and transferring assignment rights for medical payments. Starting January 1, 2026, states must verify the insurance status of individuals seeking Medicaid assistance, collecting detailed information about their third-party health insurance coverage. The bill also increases state flexibility in accepting rights of recovery and authorizations for medical services. Additionally, federal financial participation (FFP) will be unavailable for medical assistance after January 1, 2026, if states fail to obtain and verify individuals' third-party insurance information. The legislation provides flexibility for state legislatures to implement these changes, allowing states with multi-year legislative sessions adequate time to update their Medicaid plans accordingly.

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https://www.congress.gov/bill/119th-congress/house-bill/497/all-info