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 waiv-
ers under the Medicaid program. 
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 Improvement 
and State Flexibility Act of 2023’’. 
SEC. 2. PROVIDING FOR STATE APPROVAL AND IMPLEMEN-
TATION OF SPECIFIED WAIVERS UNDER THE 
MEDICAID PROGRAM. 
Section 1115 of the Social Security Act (42 U.S.C. 
1315) is amended— 
VerDate Sep 11 2014 
04:43 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H629.IH
H629
kjohnson on DSK79L0C42PROD with BILLS
(1) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘An ap-
plication’’ and inserting ‘‘Subject to paragraph 
(4), an application’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4)(A) An experimental, pilot, or demonstration 
project undertaken under subsection (a) may be approved 
or renewed by a State if such project is described in sub-
paragraph (B). 
‘‘(B) An experimental, pilot, or demonstration project 
is described in this subparagraph if such project provides 
for a waiver of requirements with respect to a State plan 
(or a waiver of such plan) under title XIX such that— 
‘‘(i) individuals enrolled under such plan (or 
such waiver) may elect to participate in such project 
with respect to a year; 
‘‘(ii) such individuals who elect to so partici-
pate— 
‘‘(I) are furnished with an electronic bene-
fits transfer card in an amount determined ap-
propriate by the State for purposes of pur-
chasing primary care services and medications 
during such year; 
VerDate Sep 11 2014 
04:43 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H629.IH
H629
kjohnson on DSK79L0C42PROD with BILLS
‘‘(II) are furnished a cash payment by the 
State equal to the amount of funds remaining 
on the individual’s electronic benefits transfer 
card at the end of such year; and 
‘‘(III) are enrolled in a catastrophic insur-
ance program determined appropriate by the 
State for purposes of covering services not de-
scribed in subclause (I) and covering services 
that are described in such subclause if such in-
dividual exceeds the amount of funds provided 
to such individual on such card for such year; 
and 
‘‘(iii) Federal expenditures under such title for 
the period during which such project is in effect are 
equal to or lesser than what such expenditures would 
have been during such period if such project were 
not in effect. 
‘‘(C)(i) In no case may a project described in sub-
paragraph (B) result in an expenditure to pay for any 
abortion or to assist in the purchase, in whole or in part, 
of health benefit coverage that includes coverage of abor-
tion. 
‘‘(ii) Clause (i) shall not apply to an abortion only 
if necessary to save the life of the mother or if the preg-
nancy is the result of an act of rape or incest. 
VerDate Sep 11 2014 
04:43 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H629.IH
H629
kjohnson on DSK79L0C42PROD with BILLS
‘‘(D) For purposes of a State’s approval or renewal 
of an experimental, pilot, or demonstration project under 
subparagraph (A), each reference to ‘the Secretary’ in 
subsection (a) shall be deemed to be a reference to ‘the 
State’.’’; and 
(2) in subsection (e), by inserting ‘‘(other than 
such a project that is described in paragraph 
(4)(B))’’ before the period at the end. 
Æ 
VerDate Sep 11 2014 
04:43 Feb 15, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H629.IH
H629
kjohnson on DSK79L0C42PROD with BILLS