Medicaid Staffing Flexibility and Protection Act of 2025
Sponsored By: Representative Carter (GA)
Introduced
Summary
Would let states hire contractors to handle Medicaid eligibility checks and fair hearings while blocking contractor ties to managed care plans. States could choose to have another State, a local agency, or a private contractor make eligibility determinations, redeterminations, and run fair hearings so long as contracts do not create incentives to delay decisions or wrongly deny coverage.
Show full summary
- Medicaid enrollees: Eligibility decisions and appeals could be handled by nonstate contractors, but contracts may not pay based on delays or denials that would harm people who qualify for medical assistance.
- State agencies: States would gain flexibility to outsource eligibility work and hearings to other states, local agencies, or private contractors as an option for administering their Medicaid program.
- Conflict-of-interest protection: A contractor chosen for these duties cannot have a direct or indirect financial relationship with any Medicaid managed care organization or with network providers affiliated with such organizations.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
States could hire firms for Medicaid decisions
If enacted, your state could hire another state, a local agency, or a private company to decide Medicaid eligibility and renewals, and to run fair hearings. Contracts would not be allowed to reward a contractor for delaying decisions or denying people who qualify. A state could only use this option if the contractor has no direct or indirect financial ties to Medicaid managed care plans or their network providers. If your state adopts this, decisions and hearings could be more timely and impartial.
Sponsors & CoSponsors
Sponsor
Carter (GA)
GA • R
Cosponsors
Davis (NC)
NC • D
Sponsored 11/21/2025
Dunn (FL)
FL • R
Sponsored 11/21/2025
Bacon
NE • R
Sponsored 11/21/2025
Valadao
CA • R
Sponsored 11/21/2025
Roll Call Votes
No roll call votes available for this bill.
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