Excluding Illegal Aliens from Medicaid Act
H.R. 4384, the Excluding Illegal Aliens from Medicaid Act, introduces two main changes to how Medicaid handles coverage of aliens (non-citizens). First, it accelerates the date by which Medicaid eligibility for certain aliens would be changed, shifting the effective date to July 4, 2025 (earlier than the previous schedule). Second, it creates an expanded federal funding mechanism (FMAP) for states that provide certain forms of health care or financial assistance to aliens who are not “qualified aliens” and who are not children or pregnant women lawfully residing in the United States. In short, the bill tightens eligibility timelines for some aliens while offering additional federal support to states that continue to cover or financially assist non-qualified aliens under specific conditions. The legislation also provides definitions and tweaks to how the federal medical assistance percentage (FMAP) is calculated, and it defines key terms like “alien” and “qualified alien” to govern eligibility and the expanded funding. Sponsor noted in the text: Rep. Steube. Status: Introduced in the 119th Congress and referred to the Committee on Energy and Commerce.
Key Points
- 1Change of effective date for alien Medicaid eligibility
- 2- The bill amends the eligibility rules by moving up the effective date for certain alien Medicaid eligibility from October 1, 2026 to July 4, 2025, making the change take effect earlier.
- 3- The adjustment is treated as if it were included in the enacted reconciliation legislation (Pub. L. 119-21).
- 4Expansion of FMAP for states that provide certain benefits to non-qualified aliens
- 5- The bill amends the Social Security Act to allow a “specified state” to receive expanded federal matching funds (FMAP) for quarters beginning on or after July 4, 2025.
- 6- A “specified state” is one that, in a given calendar quarter, either:
- 7- Uses state general-fund money to provide financial assistance (not limited to Medicaid/child health programs) to aliens who are not qualified aliens and are not lawfully residing children/pregnant women eligible for medical assistance; or
- 8- Provides any form of comprehensive health benefits coverage to such aliens, regardless of funding source.
- 9- This expansion applies to coverage or assistance for aliens who are not qualified aliens and who are not children or pregnant women lawfully residing in the U.S.
- 10Definitions and alignment of terms
- 11- The bill uses standard definitions for “alien” (as defined in the Immigration and Nationality Act) and “qualified alien” (as defined in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, with a specific interpretation tailored to the bill).
- 12- It clarifies the scope of who is considered an alien and who is a qualified alien for purposes of the eligibility and FMAP provisions.
- 13Administrative adjustments to FMAP calculations
- 14- The bill modifies certain FMAP calculation language from annual terms to quarterly terms, aligning funding with calendar quarters rather than a year-long period.