I 

118TH CONGRESS 

1ST SESSION H. R. 629 

To amend title XI of the Social Security Act to provide for State approval 

and implementation of specified waivers under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 30, 2023 

Mr. GREEN of Tennessee (for himself and Mr. BRECHEEN) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XI of the Social Security Act to provide 

for State approval and implementation of specified waivers under the Medicaid program. 

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 ‘‘Medicaid Improvement 

5 and State Flexibility Act of 2023’’. 

6 SEC. 2. PROVIDING FOR STATE APPROVAL AND IMPLEMEN7 TATION OF SPECIFIED WAIVERS UNDER THE 

8 MEDICAID PROGRAM. 

9 Section 1115 of the Social Security Act (42 U.S.C. 

10 1315) is amended— 


kjohnson on DSK79L0C42PROD with BILLS
2 

•HR 629 IH

1 (1) in subsection (d)— 

2 (A) in paragraph (1), by striking ‘‘An ap3 plication’’ and inserting ‘‘Subject to paragraph 

4 (4), an application’’; and 

5 (B) by adding at the end the following new 

6 paragraph: 

7 ‘‘(4)(A) An experimental, pilot, or demonstration 

8 project undertaken under subsection (a) may be approved 

9 or renewed by a State if such project is described in sub10 paragraph (B). 

11 ‘‘(B) An experimental, pilot, or demonstration project 

12 is described in this subparagraph if such project provides 

13 for a waiver of requirements with respect to a State plan 

14 (or a waiver of such plan) under title XIX such that— 

15 ‘‘(i) individuals enrolled under such plan (or 

16 such waiver) may elect to participate in such project 

17 with respect to a year; 

18 ‘‘(ii) such individuals who elect to so partici19 pate— 

20 ‘‘(I) are furnished with an electronic bene21 fits transfer card in an amount determined ap22 propriate by the State for purposes of pur23 chasing primary care services and medications 

24 during such year; 


kjohnson on DSK79L0C42PROD with BILLS
3 

•HR 629 IH

1 ‘‘(II) are furnished a cash payment by the 

2 State equal to the amount of funds remaining 

3 on the individual’s electronic benefits transfer 

4 card at the end of such year; and 

5 ‘‘(III) are enrolled in a catastrophic insur6 ance program determined appropriate by the 

7 State for purposes of covering services not de8 scribed in subclause (I) and covering services 

9 that are described in such subclause if such in10 dividual exceeds the amount of funds provided 

11 to such individual on such card for such year; 

12 and 

13 ‘‘(iii) Federal expenditures under such title for 

14 the period during which such project is in effect are 

15 equal to or lesser than what such expenditures would 

16 have been during such period if such project were 

17 not in effect. 

18 ‘‘(C)(i) In no case may a project described in sub19 paragraph (B) result in an expenditure to pay for any 

20 abortion or to assist in the purchase, in whole or in part, 

21 of health benefit coverage that includes coverage of abor22 tion. 

23 ‘‘(ii) Clause (i) shall not apply to an abortion only 

24 if necessary to save the life of the mother or if the preg25 nancy is the result of an act of rape or incest. 


kjohnson on DSK79L0C42PROD with BILLS
4 

•HR 629 IH

1 ‘‘(D) For purposes of a State’s approval or renewal 

2 of an experimental, pilot, or demonstration project under 

3 subparagraph (A), each reference to ‘the Secretary’ in 

4 subsection (a) shall be deemed to be a reference to ‘the 

5 State’.’’; and 

6 (2) in subsection (e), by inserting ‘‘(other than 

7 such a project that is described in paragraph 

8 (4)(B))’’ before the period at the end. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS