Medicaid RAC Improvement Act of 2026
Sponsored By: Representative Bilirakis, Gus M. [R-FL-12]
Introduced
Summary
Strengthen oversight of the Medicaid Recovery Audit Contractor program and bring Medicaid managed care into its audits. The bill would tighten CMS monitoring, require more state reporting, and set specific time limits and review windows for audit and recovery activities.
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- States: States would face new notification and reporting rules, including CMS notices of RAC exception State Plan Amendment expirations and annual state reports on how their RAC programs operate. The bill also prevents extension of certain RAC exception approvals after 2029 and requires detailed methodologies for audit limits or exclusions.
- Medicaid managed care plans and contractors: The bill would require claims paid by Medicaid managed care organizations and prepaid plans to be subject to RAC reviews and would force contracts to include either a designated payment-integrity review period of up to 18 months after payment or permission for RAC contractors to review claims. Contracts and RAC agreements must coordinate recovery activities.
- Federal transparency and participation: The Secretary must set policies within 180 days, Congress would get annual state-by-state reports starting in 2027, and a study on barriers to state RAC participation must be delivered within 1 year. The bill also sets a 4 fiscal year retrospective recovery window for audits.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
Study and demonstration to expand state Medicaid audits
If enacted, the Secretary would study why States face barriers to starting Medicaid recovery audit programs and report to Congress within 1 year. Based on that study, the Secretary would run a 5-year demonstration to increase State RAC adoption. The Secretary would start the demonstration within two years of enactment. An interim report would be due 90 days after the demo starts and a final report 180 days after it ends.
New managed-care audit rules
If enacted, State Medicaid RAC programs would have to include reviews of claims paid by Medicaid managed care plans and prepaid plans. States would need to assure, by January 1, 2028, that managed-care contracts either allow the plan an elected review period or let a State RAC contractor review claims. The elected period could not exceed the lesser of 18 months after payment or the contract term. Contracts would also require plans to cooperate with State RAC recovery efforts and allow recoupment after any elected period ends.
Stronger Medicaid RAC oversight and audits
If enacted, the Secretary would send annual reports to Congress about Medicaid RAC effectiveness starting by December 31, 2027, with state-by-state detail on recoveries, underpayments, appeals, and top initiatives. Each State would also have to send a standard report, within one year and annually after, naming who reviews each payment stream. The Secretary must report to Congress within 180 days after each State deadline and may recommend actions. Beginning 120 days after enactment, State RAC contracts would have audit and recovery coverage for the fiscal year and the four prior fiscal years. The bill would also limit any approved RAC "exceptions" so they are effective only through December 31, 2028.
Sponsors & CoSponsors
Sponsor
Bilirakis, Gus M. [R-FL-12]
FL • R
Cosponsors
Rep. Arrington, Jodey C. [R-TX-19]
TX • R
Sponsored 6/24/2026
Rep. Cammack, Kat [R-FL-3]
FL • R
Sponsored 6/24/2026
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Sponsored 6/24/2026
Rep. Miller-Meeks, Mariannette [R-IA-1]
IA • R
Sponsored 6/24/2026
Rep. Palmer, Gary J. [R-AL-6]
AL • R
Sponsored 6/24/2026
Rep. Bean, Aaron [R-FL-4]
FL • R
Sponsored 6/24/2026
Allen
GA • R
Sponsored 6/24/2026
Rep. Smucker, Lloyd [R-PA-11]
PA • R
Sponsored 7/6/2026
Roll Call Votes
No roll call votes available for this bill.
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