S 891S 2751HR 5281HR 5259119th CongressIn Committee

Bipartisan Health Care Act

Introduced: Mar 6, 2025

Chamber Versions:

Standard Summary

Comprehensive overview in 1-2 paragraphs

This bill, titled the Bipartisan Health Care Act, is designed to extend and update several expiring health provisions across Medicaid, Medicare, and related programs, with a focus on improving program access, delivery, and oversight. In the portion of the text you provided (Title I: Medicaid), the bill would streamline how out-of-state providers enroll in Medicaid and CHIP, increase transparency and accountability for home- and community-based services (HCBS) under 1915(c) waivers, remove age limits for certain working adults with disabilities, establish residency rules and protections for military families, and require more reliable address information for Medicaid enrollment. The drafters aim to improve access to care, expand some HCBS options, reduce administrative hurdles, and better align coverage with beneficiary needs. The document also sets up funding for demonstration projects and targeted implementation, though much of the text after Medicaid’s Title I is not included in the excerpt you provided. Notes: - The text provided covers Sec. 101 through Sec. 105 (Medicaid) with no detailed text for Titles II–X (Medicare, Human Services, Public Health Extenders, etc.). The summary below focuses on the sections available and notes the broader bill’s stated purpose to extend expiring health provisions. - Some provisions include dates and funding language; where explicit dates are shown in the excerpt, they are included in the summary.

Key Points

1Streamlined enrollment for eligible out-of-state Medicaid providers (Sec. 101)
2- States would adopt a streamlined process allowing eligible providers from other states to enroll to furnish services or assist eligibility determinations without burdensome screening beyond minimum necessary to ensure payment.
3- Eligible out-of-state providers would enroll for a 5-year period (unless terminated or excluded).
4- Eligibility for this streamlined process requires the provider to be located in another state, have a low risk of fraud, waste, and abuse, and be enrolled in Medicare (or meet comparable state screening criteria).
5- Effective date: provisions take effect 3 years after enactment.
6Increased transparency and potential expansion of HCBS under 1915(c) waivers (Sec. 102)
7- Requires more frequent and public reporting on HCBS waiver waitlists and service delivery (including time to start services and hours provided).
8- Adds a new reporting paragraph (11) detailing specific information states must provide about HCBS waitlists and service delivery, with data publicly available on CMS.gov beginning after enactment.
9- Establishes a new HCBS waiver demonstration program to expand HCBS coverage in up to 5 states, including:
10- Planning grants to up to 10 states (up to $5 million each) to prepare waiver proposals.
11- Criteria for selecting states emphasize rural coverage, rebalancing LTSS, and inclusion of mental health/substance use services.
12- Detailed state requirements for eligibility criteria, costs, and data reporting to monitor program impact.
13- Funding: $71 million in 2025 for implementation and related activities, with $50 million reserved for planning grants.
14Removing age restrictions on Medicaid eligibility for working adults with disabilities (Sec. 103)
15- Eliminates the 65-year-old cap for certain optional buy-in groups, broadening eligibility for working adults with disabilities.
16- States that already cover individuals described in the affected subclauses will not be deemed noncompliant under the amended rules before January 1, 2027.
17Medicaid residency and coverage for military families (Sec. 104)
18- Establishes new rules for active-duty relocated individuals, treating them as residents of the relocation state for purposes of Medicaid eligibility (unless they opt out).
19- If such individuals are on HCBS waiting lists, they remain on the list until a determination is made or they choose to be removed.
20- Provisions for payment of Medicaid services to the relocating state’s beneficiaries, as available under guidance.
21- Introduces a formal definition of “active duty relocated individual” and related HCBS waiting-list concepts.
22Address reliability for Medicaid enrollment (Sec. 105)
23- Beginning January 1, 2026, requires a process to regularly obtain and act on address information from reliable data sources to ensure enrollment and eligibility information is accurate.
24- The text in the excerpt ends mid-sentence, so full details and scope (e.g., applicability to all 50 states) are not fully shown here.

Impact Areas

Primary group/area affected- Medicaid and CHIP beneficiaries, particularly:- Individuals receiving HCBS under 1915(c) waivers (and those on waiting lists for HCBS).- Working adults with disabilities who may gain eligibility without the prior age limit.- Active-duty military families relocating between states.- Out-of-state providers who participate in Medicaid/CHIP, potentially expanding access to care.Secondary group/area affected- State Medicaid programs and their administration (screening processes, residency determinations, waitlist management, HCBS waiver administration).- Home and community-based service providers and HCBS program planners (due to new reporting, transparency requirements, and the demonstration program).- CMS and the broader health care delivery system through expanded HCBS and streamlined provider enrollment.Additional impacts- Potential cost and benefits oversight through new reporting requirements and a targeted HCBS expansion demonstration (with dedicated planning grants and implementation funding).- Improved data quality and address reliability could reduce fraud and eligibility errors, improving program integrity.HCBS (home- and community-based services): Long-term care services delivered in home or community settings instead of institutions (e.g., personal care, homemaker services, home health aide services, habilitation).1915(c) waivers: Medicaid authorities that allow states to cap enrollment and tailor services for long-term care in home/community settings under waivers to the standard state plan.Eligible out-of-State provider: A provider located in another state that is screened for fraud risk and enrolled in Medicare or meets state screening criteria, allowed to enroll in another state's Medicaid program under the streamlined process.Active duty relocated individual: A member of the armed forces or dependent who relocates to another state due to active duty, who would be treated as a resident of the relocation state for Medicaid purposes under Sec. 104.The excerpt provided ends partway through Sec. 105. The full text of many other parts of the bill (Titles II–X, including Medicare, public health programs, and pandemic preparedness) is not shown here, so this summary focuses on the sections that are included (Medicaid provisions) and notes that those other titles are listed in the table of contents but not detailed in the provided text.Expand on each provision with potential policy implications and implementation considerations.Compare these provisions to current law and note what changes would require regulatory or statutory adjustments.Track likely administrative steps, timelines, and funding flows based on the text you provided.

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