II 

118TH CONGRESS 

2D SESSION S. 3578 

To amend title XIX of the Social Security Act to prohibit Federal Medicaid 

funding for the administrative costs of providing health benefits to individuals who are unauthorized immigrants. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 11, 2024 

Mr. CASSIDY (for himself, Mrs. BLACKBURN, Mr. WICKER, Mrs. HYDESMITH, and Mr. BARRASSO) introduced the following bill; which was read 

twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to prohibit 

Federal Medicaid funding for the administrative costs 

of providing health benefits to individuals who are unauthorized immigrants. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protect Medicaid Act’’. 

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1 SEC. 2. PROHIBITING FEDERAL MEDICAID FUNDING FOR 

2 THE ADMINISTRATIVE COSTS OF PROVIDING 

3 HEALTH BENEFITS TO INDIVIDUALS WHO 

4 ARE UNAUTHORIZED IMMIGRANTS. 

5 Section 1903(i) of the Social Security Act (42 U.S.C. 

6 1396b(i)) is amended— 

7 (1) in paragraph (26), by striking ‘‘; or’’ and 

8 inserting a semicolon; 

9 (2) in paragraph (27), by striking the period at 

10 the end and inserting ‘‘; or’’; and 

11 (3) by inserting after paragraph (27) the fol12 lowing new paragraph: 

13 ‘‘(28) with respect to any amounts expended for 

14 the administration of a State program that provides 

15 health benefits to noncitizens who are ineligible for 

16 medical assistance under this title on the basis of 

17 not having a satisfactory immigration status (as de18 fined in section 1137(d)(1)(B)(iii)) (except that such 

19 prohibition shall not be construed as prohibiting 

20 payment under the preceding provisions of this sec21 tion for costs attributable to the establishment or 

22 operation of a system designed to ensure compliance 

23 with such prohibition).’’. 

24 SEC. 3. INSPECTOR GENERAL REPORT. 

25 Not later than 180 days after the date of enactment 

26 of this Act, the Inspector General of the Department of 

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1 Health and Human Services shall submit to Congress a 

2 report that includes the following information with respect 

3 to States that provide health benefits to noncitizens who 

4 are ineligible on the basis of immigration status for med5 ical assistance under title XIX of the Social Security Act 

6 (42 U.S.C. 1396 et seq.): 

7 (1) How such States separate amounts ex8 pended on the administrative costs related to the 

9 State’s Medicaid program and amounts expended on 

10 administrative costs related to providing health ben11 efits to such noncitizens. 

12 (2) The types of procedures, protocols, or sys13 tems that such States employ to ensure that they 

14 are in full compliance with prohibitions on the use 

15 of Federal funding to provide health benefits to such 

16 noncitizens and how effective they are at ensuring 

17 compliance. 

18 (3) A description of States’ methods of financ19 ing State programs that provide health benefits to 

20 noncitizens who are ineligible for medical assistance 

21 due to not having a satisfactory immigration status, 

22 including through the increased use of provider taxes 

23 and intergovernmental transfers to finance the non24 Federal share of expenditures under the State MedVerDate Sep 11 2014 04:48 Jan 13, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3578.IS S3578
4 

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1 icaid program for medical assistance provided to in2 dividuals who are not so ineligible. 

3 (4) An analysis of— 

4 (A) the extent to which such noncitizens 

5 are provided covered outpatient drugs pur6 chased under— 

7 (i) the Medicaid Drug Rebate Pro8 gram under section 1927 of the Social Se9 curity Act (42 U.S.C. 1396r–8); or 

10 (ii) the drug discount program under 

11 section 340B of the Public Health Service 

12 Act (42 U.S.C. 256b); and 

13 (B) the effect that the provision to such 

14 noncitizens of covered outpatient drugs pur15 chased under the programs described in sub16 paragraph (A) has on the average manufacturer 

17 price (as defined in section 1927(k)(1) of the 

18 Social Security Act (42 U.S.C. 1396r–8(k)(1))) 

19 of such drugs, including whether the average 

20 manufacturer price for such drugs would be 

21 lower if no drugs purchased under such pro22 grams were provided to such noncitizens. 

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