I 
119TH CONGRESS 
1ST SESSION H. R. 6254 
To amend title XIX of the Social Security Act to allow States more flexibility 
with respect to using contractors to make eligibility determinations and 
redeterminations and conduct fair hearings on behalf of the State Med-
icaid plan, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 21, 2025 
Mr. CARTER of Georgia (for himself, Mr. DAVIS of North Carolina, Mr. DUNN 
of Florida, Mr. BACON, and Mr. VALADAO) 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 allow 
States more flexibility with respect to using contractors 
to make eligibility determinations and redeterminations 
and conduct fair hearings on behalf of the State Med-
icaid plan, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Staffing 
Flexibility and Protection Act of 2025’’. 
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SEC. 2. STATE FLEXIBILITY TO USE CONTRACTORS TO 
MAKE ELIGIBILITY DETERMINATIONS, REDE-
TERMINATIONS, AND FAIR HEARINGS ON BE-
HALF OF A STATE. 
(a) REQUIREMENTS WITH RESPECT TO ELIGIBILITY 
DETERMINATIONS.—Section 1902(a)(5) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(5)) is amended by insert-
ing before the semicolon at the end the following: ‘‘, but 
such determinations of eligibility may be made, at the op-
tion of a State, under a contract with another State or 
local agency or a contractor, so long as the contract does 
not provide incentives for the agency or contractor to delay 
eligibility determinations or to deny eligibility for individ-
uals otherwise eligible for medical assistance’’. 
(b) REQUIREMENTS WITH RESPECT TO FAIR HEAR-
INGS.—Section 1902(a)(3) of the Social Security Act (42 
U.S.C. 1396a(a)(3)) is amended by inserting before the 
semicolon at the end the following: ‘‘, except that such 
fair hearing may be conducted, at the option of a State, 
under a contract with another State or local agency or 
a contractor, so long as such agency or contractor does 
not provide incentives to delay a fair hearing or to deny 
eligibility for an individual otherwise eligible for medical 
assistance’’. 
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SEC. 3. PROHIBITING CONFLICTS OF INTEREST. 
A State shall not use the flexibility provided under 
section 2 unless a contractor selected to conduct eligibility 
determinations or redeterminations pursuant to the 
amendments made by such section has no direct or indi-
rect financial relationship with any Medicaid managed 
care organization (as defined in section 1903(m)(1)(A) of 
the Social Security Act (42 U.S.C. 1396b(m)(1)(A))), in-
cluding the network providers affiliated with such organi-
zation, that provides services to individuals entitled to 
medical assistance under title XIX of such Act (42 U.S.C. 
1396 et seq.) pursuant to a contract with such State. 
Æ 
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