# Plain Language Summary: Medicaid Improvement and State Flexibility Act of 2025

## What This Bill Does

This bill gives individual states new authority to approve and run certain Medicaid pilot programs without needing federal approval from the Secretary of Health and Human Services. Currently, experimental Medicaid programs require federal government approval. This bill would allow states to independently approve and manage specific types of demonstration projects that meet certain criteria.

## Key Changes to Medicaid Programs

The bill creates a new type of Medicaid pilot program that states can implement on their own. Under this program, eligible individuals would:
- Receive an electronic benefits card loaded with state-determined funds to pay for primary care and medications
- Get a cash payment for any unused funds remaining on their card at year's end
- Be enrolled in a catastrophic insurance plan to cover major medical expenses or costs exceeding their card balance

Importantly, the program must not cost the federal government more money than traditional Medicaid would have cost during the same period.

## Who Is Affected

**Medicaid beneficiaries** would be the primary group affected, as they could choose to participate in these new programs. **States** gain significant new flexibility to design and implement their own Medicaid experiments. The bill also includes restrictions preventing these programs from funding abortion services, except in cases where abortion is necessary to save the mother's life or in cases of rape or incest.

Medicaid Improvement and State Flexibility Act of 2025

Rep. Green, Mark E. [R-TN-7]

Medicaid Improvement and State Flexibility Act of 2025This bill authorizes states to approve their own experimental, pilot, or demonstration project under Medicaid if the project provides certain benefits involving electronic benefits transfer (EBT) cards. (Currently, the Centers for Medicare &amp; Medicaid Services approves Medicaid demonstration projects; such projects are also known as Section 1115 Demonstrations.)Specifically, the project must provide enrollees who elect to participate with an EBT card to purchase primary care services; enrollees must receive any remaining balance at the end of the year in the form of a cash payment and must also obtain catastrophic health insurance.