I 

118TH CONGRESS 

1ST SESSION H. R. 5584 

To amend title XIX of the Social Security Act to provide clarification with 

respect to the liability of third party payers for medical assistance paid 

under the Medicaid program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 20, 2023 

Mr. BURGESS introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

clarification with respect to the liability of third party 

payers for medical assistance paid under the Medicaid 

program, and for other purposes. 

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 Third Party 

5 Liability Act’’. 

6 SEC. 2. MEDICAID THIRD PARTY LIABILITY. 

7 (a) REMOVAL OF SPECIAL TREATMENT OF CERTAIN

8 TYPES OF CARE AND PAYMENTS UNDER MEDICAID


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1 THIRD PARTY LIABILITY RULES.—Section 1902(a)(25) 

2 of the Social Security Act (42 U.S.C. 1396a(a)(25)) is 

3 amended by striking subparagraphs (E) and (F) and re4 designating the subsequent subparagraphs accordingly. 

5 (b) CLARIFICATION OF ROLE OF HEALTH INSURERS

6 WITH RESPECT TO THIRD PARTY LIABILITY.—Section 

7 1902(a)(25) of the Social Security Act (42 U.S.C. 

8 1396a(a)(25)), as amended by subsection (a), is further 

9 amended— 

10 (1) in subparagraph (F) (as so redesignated), 

11 by striking at the end ‘‘and’’; 

12 (2) in subparagraph (G) (as so redesignated), 

13 by striking the period at the end and inserting ‘‘; 

14 and’’; and 

15 (3) by adding at the end the following new sub16 paragraph: 

17 ‘‘(H) that, in the case of a State after Jan18 uary 1, 2024, that provides medical assistance 

19 under this title through a contract with a health 

20 insurer (including a group health plan (as de21 fined in section 607(1) of the Employee Retire22 ment Income Security Act of 1974), a self-in23 sured plan, a fully insured plan, a service ben24 efit plan, a managed care organization, a pharVerDate Sep 11 2014 02:05 Sep 23, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5584.IH H5584

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1 macy benefit manager, or any other health plan 

2 determined appropriate by the Secretary)— 

3 ‘‘(i) such contract shall specify— 

4 ‘‘(I) whether the State is dele5 gating to such insurer all or some of 

6 its right of recovery from a respon7 sible third party for an item or service 

8 for which payment has been made 

9 under the State plan (or under a 

10 waiver of the plan); and 

11 ‘‘(II) whether the State is trans12 ferring to such insurer all or some of 

13 the assignment to the State of any 

14 right of an individual or other entity 

15 to payment from a responsible third 

16 party for an item or service for which 

17 payment has been made under the 

18 State plan (or under a waiver of the 

19 plan); and 

20 ‘‘(ii) in the case of a State that elects 

21 an option described in subclause (I) or (I) 

22 of clause (i) with respect to a health in23 surer (including a group health plan (as 

24 defined in section 607(1) of the Employee 

25 Retirement Income Security Act of 1974), 


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1 a self-insured plan, a fully insured plan, a 

2 service benefit plan, a managed care orga3 nization, a pharmacy benefit manager, and 

4 any other health plan determined appro5 priate by the Secretary), the State shall 

6 provide assurances to the Secretary that 

7 the State laws referred to in subparagraph 

8 (G) confer to the health insurer the au9 thority of the State with respect to the re10 quirements specified in clauses (i) through 

11 (iv) of such subparagraph.’’. 

12 (c) INCREASING STATE FLEXIBILITY WITH RESPECT

13 TO THIRD PARTY LIABILITY.—Section 1902(a)(25)(G)(ii) 

14 of the Social Security Act (42 U.S.C. 

15 1396a(a)(25)(G)(ii)), as so redesignated by subsection (a), 

16 is amended to read as follows: 

17 ‘‘(ii) accept— 

18 ‘‘(I) the State’s right of recovery 

19 and the assignment to the State of 

20 any right of an individual or other en21 tity to payment from the party for an 

22 item or service for which payment has 

23 been made under the respective 

24 State’s plan (or under a waiver of the 

25 plan); and 


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1 ‘‘(II) after January 1, 2024, as a 

2 valid authorization of the responsible 

3 third party for the furnishing of an 

4 item or service to an individual eligi5 ble to receive medical assistance under 

6 this title, an authorization made on 

7 behalf of such individual under the 

8 State plan (or under a waiver of such 

9 plan) for the furnishing of such item 

10 or service to such individual;’’. 

11 (d) VERIFICATION OF INSURANCE STATUS RE12 QUIRED.— 

13 (1) IN GENERAL.—Section 1902(a)(25)(A)(i) of 

14 the Social Security Act (42 U.S.C. 

15 1396a(a)(25)(A)(i)) is amended by inserting ‘‘, in16 cluding the collection of, with respect to an indi17 vidual seeking to receive medical assistance under 

18 this title, information on whether the individual has 

19 health insurance coverage provided through a third 

20 party (as described in such paragraph) and the plan 

21 of such insurer in which the individual is enrolled,’’ 

22 after ‘‘in regulations)’’. 

23 (2) FFP UNAVAILABLE WITHOUT INSURANCE

24 STATUS VERIFICATION.—Section 1903(i) of the So25 cial Security Act (42 U.S.C. 1396b(i)) is amended— 


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

2 and inserting ‘‘;’’; 

3 (B) in paragraph (27), by striking ‘‘of the 

4 State.’’ and inserting ‘‘of the State; or’’; and 

5 (C) by inserting after paragraph (27) the 

6 following: 

7 ‘‘(28) with respect to any amounts after Janu8 ary 1, 2024, expended for medical assistance for in9 dividuals for whom the State has not obtained and 

10 verified, in accordance with section 

11 1902(a)(25)(A)(i), information on whether such an 

12 individual has coverage provided through a third 

13 party (as described in such paragraph) and the plan 

14 of such coverage in which the individual is en15 rolled.’’. 

16 SEC. 3. EFFECTIVE DATE. 

17 In the case of a State plan for medical assistance 

18 under title XIX of the Social Security Act that the Sec19 retary of Health and Human Services determines requires 

20 State legislation (other than legislation appropriating 

21 funds) in order for the plan to meet the additional require22 ment imposed by the amendments made under this sec23 tion, the State plan shall not be regarded as failing to 

24 comply with the requirements of such title solely on the 

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1 fore the first day of the first calendar quarter beginning 

2 after the close of the first regular session of the State leg3 islature that begins after the date of enactment of this 

4 Act. For purposes of the previous sentence, in the case 

5 of a State that has a 2-year legislative session, each year 

6 of such session shall be deemed to be a separate regular 

7 session of the State legislature. 

Æ 


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