S 2244119th CongressIn Committee

Excluding Illegal Aliens from Medicaid Act

Introduced: Jul 10, 2025

Sponsor: Sen. Paul, Rand [R-KY] (R-Kentucky)

HealthcareImmigration

Standard Summary

Comprehensive overview in 1-2 paragraphs

This bill, titled the Excluding Illegal Aliens from Medicaid Act, would make two major changes to how Medicaid deals with non-citizens (aliens) who are not considered “qualified aliens” under current law. First, it would accelerate the date when non-qualified aliens’ eligibility for Medicaid is changed (effectively restricted) from October 1, 2026 to July 4, 2025. Second, it creates a new mechanism for expanding federal funding to states that use their own funds to provide health coverage or health-insurance purchases for non-qualified aliens who are not children or pregnant women, by designating those states as “Specified States” and linking their expenditures to a higher Federal Medical Assistance Percentage (FMAP). The bill also shifts the timing and structure of FMAP calculations from annual to quarterly. In short, the bill moves to exclude non-qualified aliens from Medicaid earlier and, at the same time, offers states a potential increase in federal matching funds if they voluntarily spend state funds tocover or insure those same non-qualified aliens through health coverage programs.

Key Points

1Accelerates alien eligibility changes: Strikes the current date for alien Medicaid eligibility (October 1, 2026) and replaces it with July 4, 2025, effectiveness aligned with a broader reconciliation law process.
2FMAP expansion for certain state expenditures: Amends the FMAP statute to allow higher federal matching for states that spend general-fund money to provide health coverage or health insurance for non-qualified aliens who are not children or pregnant women, and who are not lawfully residing in the U.S.
3Specified State definition: Establishes what counts as a “Specified State” for FMAP purposes, including: (a) states that use general funds to provide any form of financial assistance for health coverage to non-qualified aliens, or (b) states that provide comprehensive health benefits coverage to non-qualified aliens, during a given quarter.
4Definitions tied to federal law: Uses existing definitions of “alien” (INA 101(a)) and “qualified alien” (PRWORA section 431, with a state-specific interpretation for certain coverage decisions).
5Quarterly FMAP calculations: Reworks FMAP timing so reimbursements for these expenditures are determined on a calendar-quarter basis rather than annually.
6Short title and status: Reiterates the bill’s short title and notes it was introduced in the Senate (sponsor listed as Mr. Paul) and referred to the Committee on Finance.

Impact Areas

Primary group/area affected- Non-qualified aliens (e.g., certain undocumented immigrants and others not meeting the “qualified alien” criteria) who would, under current law, have limited or no access to Medicaid beyond emergency services. The bill’s timing change would hasten the shift away from broader eligibility.Secondary group/area affected- States that currently provide or are considering providing health coverage or health insurance for non-qualified aliens using state funds. These states could receive a higher FMAP for those expenditures in any given quarter.Additional impacts- Federal-state financing dynamics: The bill creates a new incentive structure for states to fund health coverage for non-qualified aliens in hopes of receiving a larger federal match, altering the typical Medicaid financing balance.- Administrative and budgeting effects: Moving FMAP calculations to a quarterly basis could affect state budgeting practices and federal reconciliation processes.- Legal and policy landscape: The bill relies on existing definitions of aliens and qualified aliens but reinterprets them for Medicaid eligibility and funding purposes, which could interact with ongoing federal immigration and welfare policy debates.

Generated by gpt-5-nano on Oct 7, 2025