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HR 9345

Medicaid Equal Standards Act

119th Congress Introduced by Michael Cloud

The bill would require states to apply an SSI-style resources test to the Medicaid expansion population, potentially making some applicants ineligible starting in 2029.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 9345

Summary of H.R. 9345 — Medicaid Equal Standards Act (119th Congress)

Purpose and intent

  • The bill seeks to amend title XIX of the Social Security Act to add a resources test for eligibility under Medicaid for the expansion population. The overarching aim appears to be restricting Medicaid eligibility for certain individuals in the expansion cohort based on financial resources.

Key provisions and changes

  • New eligibility condition (resources test)

    • Introduces a new provision, Section 1902(e)(14)(M), requiring states to apply a resources test as a condition of eligibility for medical assistance for an "applicable individual" (as defined in the bill).
    • The resources test is designed to preclude eligibility if an individual’s resources exceed a specified threshold, calculated similarly to the resources standard used for the Supplemental Security Income (SSI) program (as determined under section 1613 for SSI purposes).

  • Resource threshold specifics

    • The resource amount threshold for eligibility is:
    • $10,000 for 2029.
    • For each subsequent year, the threshold increases to match the previous year’s amount, adjusted by the Consumer Price Index (CPI) changes over the four-year period ending September 30 of the prior year.
    • If the individual is married, the threshold is effectively double (i.e., resources above twice the single threshold disqualify).
    • States may:
    • Elect to use a lower amount than the standard threshold.
    • Take into account resources that would be excluded under SSI rules (i.e., adjust the test by excluding certain resources as defined by the state).

  • State flexibility and process

    • States have the flexibility to provide the threshold amounts and to apply the test at times they specify.
    • The state’s implementation must apply the test at:
    • Initial eligibility determination for new applicants.
    • Renewal/redetermination for individuals already receiving Medicaid.
    • A state’s election to apply this flexibility cannot be denied by the federal Secretary and takes effect for a period chosen by the state.

  • Treatment of ineligible individuals

    • If an applicable individual fails the resources test:
    • They would be ineligible for Medicaid under the expansion population, but the bill clarifies that this does not automatically imply the state is not providing FMAP (federal reimbursement) for other individuals who still qualify.

  • Applicable individuals and state definitions

    • The bill defines “applicable individuals” consistent with existing terms, with a provision for states to expand or designate additional categories of excluded individuals (as determined appropriate by the state).

  • State plan requirements

    • States must amend their Medicaid State plan to meet the new requirement (subsection (e)(14)(M)) as a condition of eligibility for the expansion population.

  • Effective date

    • The amendments become effective January 1, 2029.

Who would be affected

  • Expansion population eligibles in Medicaid
    • Individuals who fall into the Medicaid expansion population and apply for or renew Medicaid eligibility would be subject to the new resources test.
  • States administering Medicaid
    • State Medicaid programs would need to implement the resources test, adjust their eligibility screening and renewal processes, and update state plan documents to reflect this requirement.
  • Family income consideration
    • For married individuals, the resource threshold is effectively doubled, affecting couples differently than single individuals.

Procedural and timeline aspects

  • Authorization and referral
    • Introduced in June 2026 and referred to the House Committee on Energy and Commerce.
  • Assessment timeline
    • The resources test would apply to initial eligibility determinations and to redeterminations.
  • Effective date
    • The statutory changes would take effect on January 1, 2029.

Notes

  • The bill title is the Medicaid Equal Standards Act.
  • Co-sponsor: Representative Michael Cloud.
  • The language ties the state resources test to SSI resource standards, providing a familiar benchmark but allowing state flexibility in setting thresholds and excluding certain resources.

Compiled from official sources — confirm details with the bill’s official record.

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