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† HR 1 EAS 
‘‘(ii) beginning October 1, 2029, the system 
established by the Secretary under section 
1902(uu).’’; and 
(iv) by adding at the end the following 
new subparagraph: 
‘‘(B) Beginning October 1, 2029, the Secretary 
may determine that a State is not required to have 
in operation an eligibility determination system 
which provides for data matching (for purposes of ad-
dress verification under section 1902(vv)) through the 
system described in subparagraph (A)(i) to meet the 
requirements of this paragraph.’’. 
(B) MANAGED CARE.—Section 1932 of the 
Social Security Act (42 U.S.C. 1396u–2) is 
amended by adding at the end the following new 
subsection: 
‘‘(j) TRANSMISSION OF ADDRESS INFORMATION.—Be-
ginning January 1, 2027, each contract under a State plan 
with a managed care entity (as defined in section 
1932(a)(1)(B)) or with a prepaid inpatient health plan or 
prepaid ambulatory health plan (as such terms are defined 
in section 1903(m)(9)(D)), shall provide that such entity 
or plan shall promptly transmit to the State any address 
information for an individual enrolled with such entity or 
plan that is provided to such entity or plan directly from,
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† HR 1 EAS 
or verified by such entity or plan directly with, such indi-
vidual.’’. 
(b) CHIP.— 
(1) IN GENERAL.—Section 2107(e)(1) of the So-
cial Security Act (42 U.S.C. 1397gg(e)(1)) is amend-
ed— 
(A) by redesignating subparagraphs (H) 
through (U) as subparagraphs (I) through (V), 
respectively; and 
(B) by inserting after subparagraph (G) the 
following new subparagraph: 
‘‘(H) Section 1902(a)(88) (relating to ad-
dress information for enrollees and prevention of 
simultaneous enrollments).’’. 
(2) MANAGED CARE.—Section 2103(f)(3) of the 
Social Security Act (42 U.S.C. 1397cc(f)(3)) is 
amended by striking ‘‘and (e)’’ and inserting ‘‘(e), 
and (j)’’. 
SEC. 71104. ENSURING DECEASED INDIVIDUALS DO NOT RE-
MAIN ENROLLED. 
Section 1902 of the Social Security Act (42 U.S.C. 
1396a), as amended by section 71103, is further amended— 
(1) in subsection (a)— 
(A) in paragraph (87), by striking ‘‘; and’’ 
and inserting a semicolon;
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† HR 1 EAS 
(B) in paragraph (88), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (88) the 
following new paragraph: 
‘‘(89) provide that the State shall comply with 
the eligibility verification requirements under sub-
section (ww), except that this paragraph shall apply 
only in the case of the 50 States and the District of 
Columbia.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ww) VERIFICATION OF CERTAIN ELIGIBILITY CRI-
TERIA.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(89), the eligibility verification requirements, be-
ginning January 1, 2027, are as follows: 
‘‘(A) QUARTERLY
SCREENING
TO
VERIFY 
ENROLLEE
STATUS.—The State shall, not less 
frequently than quarterly, review the Death Mas-
ter File (as such term is defined in section 
203(d) of the Bipartisan Budget Act of 2013) or 
a successor system that provides such informa-
tion needed to determine whether any individ-
uals enrolled for medical assistance under the 
State plan (or waiver of such plan) are deceased.
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† HR 1 EAS 
‘‘(B) 
DISENROLLMENT
UNDER
STATE 
PLAN.—If the State determines, based on infor-
mation obtained from the Death Master File, 
that an individual enrolled for medical assist-
ance under the State plan (or waiver of such 
plan) is deceased, the State shall— 
‘‘(i) treat such information as factual 
information confirming the death of a bene-
ficiary; 
‘‘(ii) disenroll such individual from the 
State plan (or waiver of such plan) in ac-
cordance with subsection (a)(3); and 
‘‘(iii) discontinue any payments for 
medical assistance under this title made on 
behalf of such individual (other than pay-
ments for any items or services furnished to 
such individual prior to the death of such 
individual). 
‘‘(C) REINSTATEMENT OF COVERAGE IN THE 
EVENT OF ERROR.—If a State determines that 
an individual was misidentified as deceased 
based on information obtained from the Death 
Master File and was erroneously disenrolled 
from medical assistance under the State plan (or 
waiver 
of 
such 
plan) 
based 
on 
such
583 
† HR 1 EAS 
misidentification, the State shall immediately re- 
enroll such individual under the State plan (or 
waiver of such plan), retroactive to the date of 
such disenrollment. 
‘‘(2) RULE OF CONSTRUCTION.—Nothing under 
this subsection shall be construed to preclude the abil-
ity of a State to use other electronic data sources to 
timely identify potentially deceased beneficiaries, so 
long as the State is also in compliance with the re-
quirements of this subsection (and all other require-
ments under this title relating to Medicaid eligibility 
determination and redetermination).’’. 
SEC. 71105. ENSURING DECEASED PROVIDERS DO NOT RE-
MAIN ENROLLED. 
Section 1902(kk)(1) of the Social Security Act (42 
U.S.C. 1396a(kk)(1)) is amended— 
(1) by striking ‘‘The State’’ and inserting: 
‘‘(A) IN GENERAL.—The State’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) PROVIDER SCREENING AGAINST DEATH 
MASTER FILE.—Beginning January 1, 2028, as 
part of the enrollment (or reenrollment or re-
validation of enrollment) of a provider or sup-
plier under this title, and not less frequently
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† HR 1 EAS 
than quarterly during the period that such pro-
vider or supplier is so enrolled, the State con-
ducts a check of the Death Master File (as such 
term is defined in section 203(d) of the Bipar-
tisan Budget Act of 2013) to determine whether 
such provider or supplier is deceased.’’. 
SEC. 71106. PAYMENT REDUCTION RELATED TO CERTAIN 
ERRONEOUS EXCESS PAYMENTS UNDER MED-
ICAID. 
(a) IN GENERAL.—Section 1903(u)(1) of the Social Se-
curity Act (42 U.S.C. 1396b(u)(1)) is amended— 
(1) in subparagraph (A)— 
(A) by inserting ‘‘for audits conducted by 
the Secretary, or, at the option of the Secretary, 
audits conducted by the State’’ after ‘‘exceeds 
0.03’’; and 
(B) by inserting ‘‘, to the extent prac-
ticable’’ before the period at the end; 
(2) in subparagraph (B)— 
(A) by striking ‘‘The Secretary’’ and insert-
ing ‘‘(i) Subject to clause (ii), the Secretary’’; 
and 
(B) by adding at the end the following new 
clause:
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† HR 1 EAS 
‘‘(ii) The amount waived under clause (i) for a 
fiscal year may not exceed an amount equal to the er-
roneous excess payments for medical assistance de-
scribed in subparagraph (D)(i)(II) made for such fis-
cal year that exceed the allowable error rate of 0.03.’’. 
(3) in subparagraph (C), by striking ‘‘he’’ in 
each place it appears and inserting ‘‘the Secretary’’ 
in each such place; and 
(4) in subparagraph (D)(i)— 
(A) in subclause (I), by striking ‘‘and’’ at 
the end; 
(B) in subclause (II), by striking the period 
at the end and inserting ‘‘, or payments where 
insufficient information is available to confirm 
eligibility, and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(III) payments (other than payments described 
in subclause (I)) for items and services furnished to 
an individual who is not eligible for medical assist-
ance under the State plan (or a waiver of such plan) 
with respect to such items and services, or payments 
where insufficient information is available to confirm 
eligibility.’’.
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† HR 1 EAS 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply beginning with respect to fiscal year 
2030. 
SEC. 71107. ELIGIBILITY REDETERMINATIONS. 
(a) IN GENERAL.—Section 1902(e)(14) of the Social 
Security Act (42 U.S.C. 1396a(e)(14)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(L) FREQUENCY OF ELIGIBILITY REDETER-
MINATIONS FOR CERTAIN INDIVIDUALS.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), with respect to redeterminations of eli-
gibility for medical assistance under a State 
plan (or waiver of such plan) scheduled on 
or after the first day of the first quarter 
that begins after December 31, 2026, a State 
shall make such a redetermination once 
every 6 months for the following individ-
uals: 
‘‘(I) Individuals enrolled under 
subsection (a)(10)(A)(i)(VIII). 
‘‘(II) Individuals described in 
such subsection who are otherwise en-
rolled under a waiver of such plan that 
provides coverage that is equivalent to 
minimum essential coverage (as de-
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† HR 1 EAS 
scribed in section 5000A(f)(1)(A) of the 
Internal Revenue Code of 1986 and de-
termined in accordance with standards 
prescribed by the Secretary in regula-
tions) to all individuals described in 
subsection (a)(10)(A)(i)(VIII). 
‘‘(ii) EXEMPTION.—The requirements 
described in clause (i) shall not apply to 
any individual described in subsection 
(xx)(9)(A)(ii)(II). 
‘‘(iii) STATE DEFINED.—For purposes 
of this subparagraph, the term ‘State’ 
means 1 of the 50 States or the District of 
Columbia.’’. 
(b) GUIDANCE.—Not later than 180 days after the date 
of enactment of this section, the Secretary of Health and 
Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall issue guid-
ance relating to the implementation of the amendments 
made by this section. 
(c) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services,
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† HR 1 EAS 
$75,000,000 for fiscal year 2026, to remain available until 
expended. 
SEC. 71108. REVISING HOME EQUITY LIMIT FOR DETER-
MINING ELIGIBILITY FOR LONG-TERM CARE 
SERVICES UNDER THE MEDICAID PROGRAM. 
(a) 
REVISING
HOME
EQUITY
LIMIT.—Section 
1917(f)(1) of the Social Security Act (42 U.S.C. 
1396p(f)(1)) is amended— 
(1) in subparagraph (B)— 
(A) by striking ‘‘A State’’ and inserting 
‘‘(i) A State’’; 
(B) in clause (i), as inserted by subpara-
graph (A)— 
(i) by striking ‘‘ ‘$500,000’ ’’ and in-
serting ‘‘the amount specified in subpara-
graph (A)’’; and 
(ii) by inserting ‘‘, in the case of an 
individual’s home that is located on a lot 
that is zoned for agricultural use,’’ after 
‘‘apply subparagraph (A)’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(ii) A State may elect, without regard to the re-
quirements 
of 
section 
1902(a)(1) 
(relating 
to 
statewideness) and section 1902(a)(10)(B) (relating to
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† HR 1 EAS 
comparability), to apply subparagraph (A), in the 
case of an individual’s home that is not described in 
clause (i), by substituting for the amount specified in 
such subparagraph, an amount that exceeds such 
amount, but does not exceed $1,000,000.’’; and 
(2) in subparagraph (C)— 
(A) by inserting ‘‘(other than the amount 
specified in subparagraph (B)(ii) (relating to 
certain non-agricultural homes))’’ after ‘‘speci-
fied in this paragraph’’; and 
(B) by adding at the end the following new 
sentence: ‘‘In the case that application of the pre-
ceding sentence would result in a dollar amount 
(other than the amount specified in subpara-
graph (B)(i) (relating to certain agricultural 
homes)) exceeding $1,000,000, such amount shall 
be deemed to be equal to $1,000,000.’’. 
(b) CLARIFICATION.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (r)(2), by adding at the end the 
following new subparagraph: 
‘‘(C) This paragraph shall not be construed as permit-
ting a State to determine the eligibility of an individual 
for medical assistance with respect to nursing facility serv-
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† HR 1 EAS 
ices or other long-term care services without application of 
the limit under section 1917(f)(1).’’; and 
(2) in subsection (e)(14)(D)(iv)— 
(A) by striking ‘‘Subparagraphs’’ and in-
serting 
‘‘(I) 
IN
GENERAL.—Subpara-
graphs’’; and 
(B) by adding at the end the following new 
subclause: 
‘‘(II) APPLICATION OF HOME EQ-
UITY
INTEREST
LIMIT.—Section 
1917(f) shall apply for purposes of de-
termining the eligibility of an indi-
vidual for medical assistance with re-
spect to nursing facility services or 
other long-term care services.’’. 
(c) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply beginning on January 1, 2028. 
SEC. 71109. ALIEN MEDICAID ELIGIBILITY. 
(a) MEDICAID.—Section 1903(v) of the Social Security 
Act (42 U.S.C. 1396b(v)) is amended— 
(1) in paragraph (1), by striking ‘‘and (4)’’and 
inserting ‘‘, (4), and (5)’’; and 
(2) by adding at the end the following new para-
graph:
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† HR 1 EAS 
‘‘(5) Notwithstanding the preceding paragraphs of this 
subsection, beginning on October 1, 2026, except as provided 
in paragraphs (2) and (4), in no event shall payment be 
made to a State under this section for medical assistance 
furnished to an individual unless such individual is— 
‘‘(A) a resident of 1 of the 50 States, the District 
of Columbia, or a territory of the United States; and 
‘‘(B) either— 
‘‘(i) a citizen or national of the United 
States; 
‘‘(ii) an alien lawfully admitted for perma-
nent residence as an immigrant as defined by 
sections 101(a)(15) and 101(a)(20) of the Immi-
gration and Nationality Act, excluding, among 
others, alien visitors, tourists, diplomats, and 
students who enter the United States temporarily 
with no intention of abandoning their residence 
in a foreign country; 
‘‘(iii) an alien who has been granted the 
status of Cuban and Haitian entrant, as defined 
in section 501(e) of the Refugee Education As-
sistance Act of 1980 (Public Law 96–422); or 
‘‘(iv) an individual who lawfully resides in 
the United States in accordance with a Compact 
of Free Association referred to in section
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† HR 1 EAS 
402(b)(2)(G) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996.’’. 
(b) CHIP.—Section 2107(e)(1) of the Social Security 
Act, as amended by section 71103(b), is further amended— 
(1) by redesignating subparagraphs (R) through 
(V) as paragraphs (S) through (W), respectively; and 
(2) by inserting after paragraph (Q) the fol-
lowing: 
‘‘(R) Section 1903(v)(5) (relating to pay-
ments for medical assistance furnished to aliens), 
except in relation to payments for services pro-
vided under section 2105(a)(1)(D)(ii).’’. 
(c) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$15,000,000 for fiscal year 2026, to remain available until 
expended. 
SEC. 71110. EXPANSION FMAP FOR EMERGENCY MEDICAID. 
(a) IN GENERAL.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d) is amended by adding at the end 
the following new subsection: 
‘‘(kk) FMAP FOR TREATMENT OF AN EMERGENCY 
MEDICAL CONDITION.—Notwithstanding subsection (y) and
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† HR 1 EAS 
(z), beginning on October 1, 2026, the Federal medical as-
sistance percentage for payments for care and services de-
scribed in paragraph (2) of subsection 1903(v) furnished 
to an alien described in paragraph (1) of such subsection 
shall not exceed the Federal medical assistance percentage 
determined under subsection (b) for such State.’’. 
(b) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$1,000,000 for fiscal year 2026, to remain available until 
expended. 
Subchapter B—Preventing Wasteful Spending 
SEC. 71111. MORATORIUM ON IMPLEMENTATION OF RULE 
RELATING TO STAFFING STANDARDS FOR 
LONG-TERM CARE FACILITIES UNDER THE 
MEDICARE AND MEDICAID PROGRAMS. 
The Secretary of Health and Human Services shall 
not, during the period beginning on the date of the enact-
ment of this section and ending September 30, 2034, imple-
ment, administer, or enforce the amendments made by the 
provisions of the final rule published by the Centers for 
Medicare & Medicaid Services on May 10, 2024, and titled 
‘‘Medicare and Medicaid Programs; Minimum Staffing
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† HR 1 EAS 
Standards for Long-Term Care Facilities and Medicaid In-
stitutional Payment Transparency Reporting’’ (89 Fed. 
Reg. 40876) to the following sections of part 483 of title 
42, Code of Federal Regulations: 
(1) Section 483.5. 
(2) Section 483.35. 
SEC. 71112. REDUCING STATE MEDICAID COSTS. 
(a) IN GENERAL.—Section 1902(a)(34) of the Social 
Security Act (42 U.S.C. 1396a(a)(34)) is amended to read 
as follows: 
‘‘(34) provide that in the case of any individual 
who has been determined to be eligible for medical as-
sistance under the plan and— 
‘‘(A) 
is 
enrolled 
under 
paragraph 
(10)(A)(i)(VIII), such assistance will be made 
available to the individual for care and services 
included under the plan and furnished in or 
after the month before the month in which the 
individual made application (or application was 
made on the individual’s behalf in the case of a 
deceased individual) for such assistance if such 
individual was (or upon application would have 
been) eligible for such assistance at the time such 
care and services were furnished; or
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† HR 1 EAS 
‘‘(B) is not described in subparagraph (A), 
such assistance will be made available to the in-
dividual for care and services included under the 
plan and furnished in or after the second month 
before the month in which the individual made 
application (or application was made on the in-
dividual’s behalf in the case of a deceased indi-
vidual) for such assistance if such individual 
was (or upon application would have been) eligi-
ble for such assistance at the time such care and 
services were furnished;’’. 
(b) DEFINITION OF MEDICAL ASSISTANCE.—Section 
1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) 
is amended by striking ‘‘in or after the third month before 
the month in which the recipient makes application for as-
sistance’’ and inserting ‘‘, with respect to an individual de-
scribed in section 1902(a)(34)(A), in or after the month be-
fore the month in which the recipient makes application 
for assistance, and with respect to an individual described 
in section 1902(a)(34)(B), in or after the second month be-
fore the month in which the recipient makes application 
for assistance’’. 
(c) CHIP.—Section 2102(b)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1397bb(b)(1)(B)) is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end;
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† HR 1 EAS 
(2) in clause (v), by striking the period and in-
serting ‘‘; and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(vi) shall, in the case that the State 
elects to provide child health or pregnancy- 
related assistance to an individual for any 
period prior to the month in which the in-
dividual made application for such assist-
ance (or application was made on behalf of 
the individual), provide that such assistance 
is not made available to such individual for 
items and services included under the State 
child health plan (or waiver of such plan) 
that are furnished before the second month 
preceding the month in which such indi-
vidual made application (or application 
was made on behalf of such individual) for 
assistance.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to medical assistance, child health as-
sistance, and pregnancy-related assistance with respect to 
individuals whose eligibility for such medical assistance, 
child health assistance, or pregnancy-related assistance is
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† HR 1 EAS 
based on an application made on or after the first day of 
the first quarter that begins after December 31, 2026. 
(e) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$10,000,000 for fiscal year 2026, to remain available until 
expended. 
SEC. 71113. FEDERAL PAYMENTS TO PROHIBITED ENTITIES. 
(a) IN GENERAL.—No Federal funds that are consid-
ered direct spending and provided to carry out a State plan 
under title XIX of the Social Security Act or a waiver of 
such a plan shall be used to make payments to a prohibited 
entity for items and services furnished during the 1-year 
period beginning on the date of the enactment of this Act, 
including any payments made directly to the prohibited en-
tity or under a contract or other arrangement between a 
State and a covered organization. 
(b) DEFINITIONS.—In this section: 
(1) PROHIBITED ENTITY.—The term ‘‘prohibited 
entity’’ means an entity, including its affiliates, sub-
sidiaries, successors, and clinics—
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† HR 1 EAS 
(A) that, as of the first day of the first 
quarter beginning after the date of enactment of 
this Act— 
(i) is an organization described in sec-
tion 501(c)(3) of the Internal Revenue Code 
of 1986 and exempt from tax under section 
501(a) of such Code; 
(ii) is an essential community provider 
described in section 156.235 of title 45, 
Code of Federal Regulations (as in effect on 
the date of enactment of this Act), that is 
primarily engaged in family planning serv-
ices, reproductive health, and related med-
ical care; and 
(iii) provides for abortions, other than 
an abortion— 
(I) if the pregnancy is the result 
of an act of rape or incest; or 
(II) in the case where a woman 
suffers from a physical disorder, phys-
ical injury, or physical illness, includ-
ing a life-endangering physical condi-
tion caused by or arising from the 
pregnancy itself, that would, as cer-
tified by a physician, place the woman
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† HR 1 EAS 
in danger of death unless an abortion 
is performed; and 
(B) for which the total amount of Federal 
and State expenditures under the Medicaid pro-
gram under title XIX of the Social Security Act 
for medical assistance furnished in fiscal year 
2023 made directly, or by a covered organiza-
tion, to the entity or to any affiliates, subsidi-
aries, successors, or clinics of the entity, or made 
to the entity or to any affiliates, subsidiaries, 
successors, or clinics of the entity as part of a 
nationwide health care provider network, exceed-
ed $800,000. 
(2) DIRECT SPENDING.—The term ‘‘direct spend-
ing’’ has the meaning given that term under section 
250(c) of the Balanced Budget and Emergency Deficit 
Control Act of 1985 (2 U.S.C. 900(c)). 
(3) COVERED
ORGANIZATION.—The term ‘‘cov-
ered organization’’ means a managed care entity (as 
defined in section 1932(a)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1396u–2(a)(1)(B))) or a prepaid 
inpatient health plan or prepaid ambulatory health 
plan 
(as 
such 
terms 
are 
defined 
in 
section 
1903(m)(9)(D) 
of 
such 
Act 
(42 
U.S.C. 
1396b(m)(9)(D))).
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† HR 1 EAS 
(4) STATE.—The term ‘‘State’’ has the meaning 
given such term in section 1101 of the Social Security 
Act (42 U.S.C. 1301). 
(c) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out this section, there are appropriated, out of any 
monies in the Treasury not otherwise appropriated, to the 
Administrator of the Centers for Medicare & Medicaid Serv-
ices, $1,000,000 for fiscal year 2026, to remain available 
until expended. 
Subchapter C—Stopping Abusive Financing 
Practices 
SEC. 71114. SUNSETTING INCREASED FMAP INCENTIVE. 
Section 1905(ii)(3) of the Social Security Act (42 
U.S.C. 1396d(ii)(3)) is amended— 
(1) by striking ‘‘which has not’’ and inserting 
the following: ‘‘which— 
‘‘(A) has not’’; 
(2) in subparagraph (A), as so inserted, by strik-
ing the period at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) begins to expend amounts for all such 
individuals prior to January 1, 2026.’’.
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† HR 1 EAS 
SEC. 71115. PROVIDER TAXES. 
(a) CHANGE IN THRESHOLD FOR HOLD HARMLESS 
PROVISION
OF BROAD-BASED HEALTH CARE RELATED 
TAXES.—Section 1903(w)(4) of the Social Security Act (42 
U.S.C. 1396b(w)(4)) is amended— 
(1) in subparagraph (C)(ii), by inserting ‘‘, and 
for fiscal years beginning on or after October 1, 2026, 
the applicable percent determined under subpara-
graph (D) shall be substituted for ‘6 percent’ each 
place it appears’’ after ‘‘each place it appears’’; and 
(2) by inserting after subparagraph (C)(ii), the 
following new subparagraph: 
‘‘(D)(i) For purposes of subparagraph (C)(ii), 
the applicable percent determined under this subpara-
graph is— 
‘‘(I) in the case of a non-expansion State or 
unit of local government in such State and a 
class of health care items or services described in 
section 433.56(a) of title 42, Code of Federal 
Regulations (as in effect on May 1, 2025)— 
‘‘(aa) if, on the date of enactment of 
this subparagraph, the non-expansion State 
or unit of local government in such State 
has enacted a tax and imposes such tax on 
such class and the Secretary determines that 
the tax is within the hold harmless threshold
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† HR 1 EAS 
as of that date, the applicable percent of net 
patient revenue attributable to such class 
that has been so determined; and 
‘‘(bb) if, on the date of enactment of 
this subparagraph, the non-expansion State 
or unit of local government in such State 
has not enacted or does not impose a tax 
with respect to such class, 0 percent; and 
‘‘(II) in the case of an expansion State or 
unit of local government in such State and a 
class of health care items or services described in 
section 433.56(a) of title 42, Code of Federal 
Regulations (as in effect on May 1, 2025), sub-
ject to clause (iv)— 
‘‘(aa) if, on the date of enactment of 
this subparagraph, the expansion State or 
unit of local government in such State has 
enacted a tax and imposes such tax on such 
class and the Secretary determines that the 
tax is within the hold harmless threshold as 
of that date, the lower of— 
‘‘(AA) the applicable percent of 
net patient revenue attributable to such 
class that has been so determined; and
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† HR 1 EAS 
‘‘(BB) the applicable percent spec-
ified in clause (ii) for the fiscal year; 
and 
‘‘(bb) if, on the date of enactment of 
this subparagraph, the expansion State or 
unit of local government in such State has 
not enacted or does not impose a tax with 
respect to such class, 0 percent. 
‘‘(ii) For purposes of clause (i)(II)(aa)(BB), 
the applicable percent is— 
‘‘(I) for fiscal year 2028, 5.5 percent; 
‘‘(II) for fiscal year 2029, 5 percent; 
‘‘(III) for fiscal year 2030, 4.5 percent; 
‘‘(IV) for fiscal year 2031, 4 percent; 
and 
‘‘(V) for fiscal year 2032 and each sub-
sequent fiscal year, 3.5 percent. 
‘‘(iii) For purposes of clause (i): 
‘‘(I) EXPANSION STATE.—The term ‘ex-
pansion State’ means a State that, begin-
ning on January 1, 2014, or on any date 
thereafter, elects to provide medical assist-
ance to all individuals described in section 
1902(a)(10)(A)(i)(VIII) under the State
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† HR 1 EAS 
plan under this title or under a waiver of 
such plan. 
‘‘(II) 
NON-EXPANSION
STATE.—The 
term ‘non-expansion State’ means a State 
that is not an expansion State. 
‘‘(iv) In the case of a tax of an expansion 
State or unit of local government in such State 
in effect on the date of enactment of this clause, 
that applies to a class of health care items or 
services that is described in paragraph (3) or (4) 
of section 433.56(a) of title 42, Code of Federal 
Regulations (as in effect on May 1, 2025), and 
for which, on such date of enactment, is within 
the hold harmless threshold (as determined by the 
Secretary), the applicable percent of net patient 
revenue attributable to such class that has been 
so determined shall apply for a fiscal year in-
stead of the applicable percent specified in clause 
(ii) for the fiscal year.’’. 
(b) NON-APPLICATION TO TERRITORIES.—The amend-
ments made by this section shall only apply with respect 
to a State that is 1 of the 50 States or the District of Colum-
bia. 
(c) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made
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by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$20,000,000 for fiscal year 2026, to remain available until 
expended. 
SEC. 71116. STATE DIRECTED PAYMENTS. 
(a) IN GENERAL.—Subject to subsection (b), the Sec-
retary of Health and Human Services (in this section re-
ferred 
to 
as 
the 
Secretary) 
shall 
revise 
section 
438.6(c)(2)(iii) of title 42, Code of Federal Regulations (or 
a successor regulation) such that, with respect to a payment 
described in such section made for a service furnished dur-
ing a rating period beginning on or after the date of the 
enactment of this Act, the total payment rate for such serv-
ice is limited to— 
(1) in the case of a State that provides coverage 
to 
all 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)(i)(VIII)) that is equivalent to 
minimum essential coverage (as described in section 
5000A(f)(1)(A) of the Internal Revenue Code of 1986 
and determined in accordance with standards pre-
scribed by the Secretary in regulations) under the 
State plan (or waiver of such plan) of such State 
under title XIX of such Act, 100 percent of the speci-
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† HR 1 EAS 
fied total published Medicare payment rate (or, in the 
absence of a specified total published Medicare pay-
ment rate, the payment rate under a Medicaid State 
plan (or under a waiver of such plan)); or 
(2) in the case of a State other than a State de-
scribed in paragraph (1), 110 percent of the specified 
total published Medicare payment rate (or, in the ab-
sence of a specified total published Medicare payment 
rate, the payment rate under a Medicaid State plan 
(or under a waiver of such plan)). 
(b) GRANDFATHERING CERTAIN PAYMENTS.—In the 
case of a payment described in section 438.6(c)(2)(iii) of 
title 42, Code of Federal Regulations (or a successor regula-
tion) for which written prior approval (or a good faith ef-
fort to receive such approval, as determined by the Sec-
retary) was made before May 1, 2025, or a payment de-
scribed in such section for a rural hospital (as defined in 
subsection (d)(2)) for which written prior approval (or a 
good faith effort to receive such approval, as determined by 
the Secretary) was made by the date of enactment of this 
Act, for the rating period occurring within 180 days of the 
date of the enactment of this Act, or a payment so described 
for such rating period for which a completed preprint was 
submitted to the Secretary prior to the date of enactment 
of this Act, beginning with the rating period on or after
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† HR 1 EAS 
January 1, 2028, the total amount of such payment shall 
be reduced by 10 percentage points each year until the total 
payment rate for such service is equal to the rate for such 
service specified in subsection (a). 
(c) TREATMENT OF EXPANSION STATES.—The revi-
sions described in subsection (a) shall provide that, with 
respect to a State that begins providing the coverage de-
scribed in paragraph (1) of such subsection on or after the 
date of the enactment of this Act, the limitation described 
in such paragraph shall apply to such State with respect 
to a payment described in section 438.6(c)(2)(iii) of title 
42, Code of Federal Regulations (or a successor regulation) 
for a service furnished during a rating period beginning 
on or after the date of enactment of this Act. 
(d) DEFINITIONS.—In this section: 
(1) RATING PERIOD.—The term ‘‘rating period’’ 
has the meaning given such term in section 438.2 of 
title 42, Code of Federal Regulations (or a successor 
regulation). 
(2) RURAL
HOSPITAL.—The term ‘‘rural hos-
pital’’ means the following: 
(A) A subsection (d) hospital (as defined in 
paragraph (1)(B) of section 1886(d) of the Social 
Security Act (42 U.S.C. 1395ww(d))) that—
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† HR 1 EAS 
(i) is located in a rural area (as de-
fined in paragraph (2)(D) of such section); 
(ii) is treated as being located in a 
rural area pursuant to paragraph (8)(E) of 
such section; or 
(iii) is located in a rural census tract 
of a metropolitan statistical area (as deter-
mined under the most recent modification of 
the Goldsmith Modification, originally pub-
lished in the Federal Register on February 
27, 1992 (57 Fed. Reg. 6725)). 
(B) A critical access hospital (as defined in 
section 1861(mm)(1) of such Act (42 U.S.C. 
1395x(mm)(1))). 
(C) A sole community hospital (as defined 
in section 1886(d)(5)(D)(iii) of such Act (42 
U.S.C. 1395ww(d)(5)(D)(iii))). 
(D) A Medicare-dependent, small rural hos-
pital (as defined in section 1886(d)(5)(G)(iv) of 
such Act (42 U.S.C. 1395ww(d)(5)(G)(iv))). 
(E) A low-volume hospital (as defined in 
section 1886(d)(12)(C) of such Act (42 U.S.C. 
1395ww(d)(12)(C))).
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† HR 1 EAS 
(F) A rural emergency hospital (as defined 
in section 1861(kkk)(2) of such Act (42 U.S.C. 
1395x(kkk)(2))). 
(3) STATE.—The term ‘‘State’’ means 1 of the 50 
States or the District of Columbia. 
(4) TOTAL
PUBLISHED
MEDICARE
PAYMENT 
RATE.—The term ‘‘total published Medicare payment 
rate’’ has the meaning given to such term in section 
438.6(a) of title 42, Code of Federal Regulations (or 
a successor regulation). 
(5) WRITTEN
PRIOR
APPROVAL.—The term 
‘‘written prior approval’’ has the meaning given to 
such term in section 438.6(c)(2)(i) of title 42, Code of 
Federal Regulations (or a successor regulation). 
(e) FUNDING.—There are appropriated out of any 
monies in the Treasury not otherwise appropriated 
$7,000,000 for each of fiscal years 2026 through 2033 for 
purposes of carrying out this section, to remain available 
until expended. 
SEC. 71117. REQUIREMENTS REGARDING WAIVER OF UNI-
FORM TAX REQUIREMENT FOR MEDICAID 
PROVIDER TAX. 
(a) IN GENERAL.—Section 1903(w) of the Social Secu-
rity Act (42 U.S.C. 1396b(w)) is amended—
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† HR 1 EAS 
(1) in paragraph (3)(E), by inserting after 
clause (ii)(II) the following new clause: 
‘‘(iii) For purposes of clause (ii)(I), a tax is not con-
sidered to be generally redistributive if any of the following 
conditions apply: 
‘‘(I) Within a permissible class, the tax rate im-
posed on any taxpayer or tax rate group (as defined 
in paragraph (7)(J)) explicitly defined by its rel-
atively lower volume or percentage of Medicaid tax-
able units (as defined in paragraph (7)(H)) is lower 
than the tax rate imposed on any other taxpayer or 
tax rate group explicitly defined by its relatively 
higher volume or percentage of Medicaid taxable 
units. 
‘‘(II) Within a permissible class, the tax rate im-
posed on any taxpayer or tax rate group (as so de-
fined) based upon its Medicaid taxable units (as so 
defined) is higher than the tax rate imposed on any 
taxpayer or tax rate group based upon its non-Med-
icaid taxable unit (as defined in paragraph (7)(I)). 
‘‘(III) The tax excludes or imposes a lower tax 
rate on a taxpayer or tax rate group (as so defined) 
based on or defined by any description that results in 
the same effect as described in subclause (I) or (II) for 
a taxpayer or tax rate group. Characteristics that
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† HR 1 EAS 
may indicate such type of exclusion include the use 
of terminology to establish a tax rate group— 
‘‘(aa) based on payments or expenditures 
made under the program under this title without 
mentioning the term ‘Medicaid’ (or any similar 
term) to accomplish the same effect as described 
in subclause (I) or (II); or 
‘‘(bb) that closely approximates a taxpayer 
or tax rate group under the program under this 
title, to the same effect as described in subclause 
(I) or (II).’’; and 
(2) in paragraph (7), by adding at the end the 
following new subparagraphs: 
‘‘(H) The term ‘Medicaid taxable unit’ means a 
unit that is being taxed within a health care related 
tax that is applicable to the program under this title. 
Such term includes a unit that is used as the basis 
for— 
‘‘(i) payment under the program under this 
title (such as Medicaid bed days); 
‘‘(ii) Medicaid revenue; 
‘‘(iii) costs associated with the program 
under this title (such as Medicaid charges, 
claims, or expenditures); and
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† HR 1 EAS 
‘‘(iv) other units associated with the pro-
gram under this title, as determined by the Sec-
retary. 
‘‘(I) The term ‘non-Medicaid taxable unit’ means 
a unit that is being taxed within a health care related 
tax that is not applicable to the program under this 
title. Such term includes a unit that is used as the 
basis for— 
‘‘(i) payment by non-Medicaid payers (such 
as non-Medicaid bed days); 
‘‘(ii) non-Medicaid revenue; 
‘‘(iii) costs that are not associated with the 
program under this title (such as non-Medicaid 
charges, non-Medicaid claims, or non-Medicaid 
expenditures); and 
‘‘(iv) other units not associated with the 
program under this title, as determined by the 
Secretary. 
‘‘(J) The term ‘tax rate group’ means a group of 
entities contained within a permissible class of a 
health care related tax that are taxed at the same 
rate.’’. 
(b) NON-APPLICATION TO TERRITORIES.—The amend-
ments made by this section shall only apply with respect
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† HR 1 EAS 
to a State that is 1 of the 50 States or the District of Colum-
bia. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect upon the date of enactment of this 
Act, subject to any applicable transition period determined 
appropriate by the Secretary of Health and Human Serv-
ices, not to exceed 3 fiscal years. 
SEC. 71118. REQUIRING BUDGET NEUTRALITY FOR MED-
ICAID DEMONSTRATION PROJECTS UNDER 
SECTION 1115. 
(a) IN GENERAL.—Section 1115 of the Social Security 
Act (42 U.S.C. 1315) is amended by adding at the end the 
following new subsection: 
‘‘(g) REQUIREMENT
OF BUDGET NEUTRALITY
FOR 
MEDICAID DEMONSTRATION PROJECTS.— 
‘‘(1) IN GENERAL.—Beginning January 1 2027, 
the Secretary may not approve an application for (or 
renewal or amendment of) an experimental, pilot, or 
demonstration project undertaken under subsection 
(a) to promote the objectives of title XIX in a State 
(in this subsection referred to as a ‘Medicaid dem-
onstration project’) unless the Chief Actuary for the 
Centers for Medicare & Medicaid Services certifies 
that such project, or, in the case of a renewal, the du-
ration of the preceding waiver, is not expected to re-
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† HR 1 EAS 
sult in an increase in the amount of Federal expendi-
tures compared to the amount that such expenditures 
would otherwise be in the absence of such project. For 
purposes of this subsection, expenditures for the cov-
erage of populations and services that the State could 
have otherwise provided through its Medicaid State 
plan or other authority under title XIX, including ex-
penditures that could be made under such authority 
but for the provision of such services at a different 
site of service than authorized under such State plan 
or other authority, shall be considered expenditures in 
the absence of such a project. 
‘‘(2) TREATMENT OF SAVINGS.—In the event that 
expenditures with respect to a State under a Medicaid 
demonstration project are, during an approval period 
for such project, less than the amount of such expendi-
tures that would have otherwise been made in the ab-
sence of such project, the Secretary shall specify the 
methodology to be used with respect to the subsequent 
approval period for such project for purposes of tak-
ing the difference between such expenditures into ac-
count.’’. 
(b) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies
615 
† HR 1 EAS 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$5,000,000 for each of fiscal years 2026 and 2027, to re-
main available until expended. 
Subchapter D—Increasing Personal 
Accountability 
SEC. 71119. REQUIREMENT FOR STATES TO ESTABLISH 
MEDICAID 
COMMUNITY 
ENGAGEMENT 
RE-
QUIREMENTS FOR CERTAIN INDIVIDUALS. 
(a) IN GENERAL.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396a), as amended by sections 71103 and 
71104, is further amended by adding at the end the fol-
lowing new subsection: 
‘‘(xx) COMMUNITY ENGAGEMENT REQUIREMENT FOR 
APPLICABLE INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (11), beginning not later than the first day of 
the first quarter that begins after December 31, 2026, 
or, at the option of the State under a waiver or dem-
onstration project under section 1115 or the State 
plan, such earlier date as the State may specify, sub-
ject to the succeeding provisions of this subsection, a 
State shall provide, as a condition of eligibility for 
medical assistance for an applicable individual, that
616 
† HR 1 EAS 
such individual is required to demonstrate commu-
nity engagement under paragraph (2)— 
‘‘(A) in the case of an applicable individual 
who has filed an application for medical assist-
ance under a State plan (or a waiver of such 
plan) under this title, for 1 or more but not more 
than 3 (as specified by the State) consecutive 
months immediately preceding the month during 
which such individual applies for such medical 
assistance; and 
‘‘(B) in the case of an applicable individual 
enrolled and receiving medical assistance under 
a State plan (or under a waiver of such plan) 
under this title, for 1 or more (as specified by the 
State) months, whether or not consecutive— 
‘‘(i) during the period between such in-
dividual’s most recent determination (or re-
determination, as applicable) of eligibility 
and such individual’s next regularly sched-
uled redetermination of eligibility (as 
verified by the State as part of such regu-
larly scheduled redetermination of eligi-
bility); or 
‘‘(ii) in the case of a State that has 
elected under paragraph (4) to conduct
617 
† HR 1 EAS 
more frequent verifications of compliance 
with the requirement to demonstrate com-
munity engagement, during the period be-
tween the most recent and next such 
verification with respect to such individual. 
‘‘(2) COMMUNITY ENGAGEMENT COMPLIANCE DE-
SCRIBED.—Subject to paragraph (3), an applicable 
individual 
demonstrates 
community 
engagement 
under this paragraph for a month if such individual 
meets 1 or more of the following conditions with re-
spect to such month, as determined in accordance 
with criteria established by the Secretary through reg-
ulation: 
‘‘(A) The individual works not less than 80 
hours. 
‘‘(B) The individual completes not less than 
80 hours of community service. 
‘‘(C) The individual participates in a work 
program for not less than 80 hours. 
‘‘(D) The individual is enrolled in an edu-
cational program at least half-time. 
‘‘(E) The individual engages in any com-
bination of the activities described in subpara-
graphs (A) through (D), for a total of not less 
than 80 hours.
618 
† HR 1 EAS 
‘‘(F) The individual has a monthly income 
that is not less than the applicable minimum 
wage requirement under section 6 of the Fair 
Labor Standards Act of 1938, multiplied by 80 
hours. 
‘‘(G) The individual had an average month-
ly income over the preceding 6 months that is 
not less than the applicable minimum wage re-
quirement under section 6 of the Fair Labor 
Standards Act of 1938 multiplied by 80 hours, 
and is a seasonal worker, as described in section 
45R(d)(5)(B) of the Internal Revenue Code of 
1986 . 
‘‘(3) EXCEPTIONS.— 
‘‘(A) MANDATORY EXCEPTION FOR CERTAIN 
INDIVIDUALS.—The State shall deem an applica-
ble individual to have demonstrated community 
engagement under paragraph (2) for a month, 
and may elect to not require an individual to 
verify information resulting in such deeming, 
if— 
‘‘(i) for part or all of such month, the 
individual—
619 
† HR 1 EAS 
‘‘(I) was a specified excluded indi-
vidual 
(as 
defined 
in 
paragraph 
(9)(A)(ii)); or 
‘‘(II) was— 
‘‘(aa) under the age of 19; 
‘‘(bb) entitled to, or enrolled 
for, benefits under part A of title 
XVIII, or enrolled for benefits 
under part B of title XVIII; or 
‘‘(cc) described in any of sub-
clauses (I) through (VII) of sub-
section (a)(10)(A)(i); or 
‘‘(ii) at any point during the 3-month 
period ending on the first day of such 
month, the individual was an inmate of a 
public institution. 
‘‘(B) OPTIONAL
EXCEPTION
FOR
SHORT- 
TERM HARDSHIP EVENTS.— 
‘‘(i) IN GENERAL.—The State plan (or 
waiver of such plan) may provide, in the 
case of an applicable individual who experi-
ences a short-term hardship event during a 
month, that the State shall, under proce-
dures established by the State (in accord-
ance with standards specified by the Sec-
620 
† HR 1 EAS 
retary), in the case of a short-term hardship 
event described in clause (ii)(II) and, upon 
the request of such individual, a short-term 
hardship event described in subclause (I) or 
(III) of clause (ii), deem such individual to 
have demonstrated community engagement 
under paragraph (2) for such month. 
‘‘(ii) SHORT-TERM
HARDSHIP
EVENT 
DEFINED.—For purposes of this subpara-
graph, an applicable individual experiences 
a short-term hardship event during a month 
if, for part or all of such month— 
‘‘(I) such individual receives in-
patient hospital services, nursing facil-
ity services, services in an intermediate 
care facility for individuals with intel-
lectual 
disabilities, 
inpatient 
psy-
chiatric hospital services, or such other 
services of similar acuity (including 
outpatient care relating to other serv-
ices specified in this subclause) as the 
Secretary determines appropriate; 
‘‘(II) such individual resides in a 
county (or equivalent unit of local gov-
ernment)—
621 
† HR 1 EAS 
‘‘(aa) in which there exists 
an emergency or disaster declared 
by the President pursuant to the 
National Emergencies Act or the 
Robert T. Stafford Disaster Relief 
and Emergency Assistance Act; or 
‘‘(bb) that, subject to a re-
quest from the State to the Sec-
retary, made in such form, at 
such time, and containing such 
information as the Secretary may 
require, has an unemployment 
rate that is at or above the lesser 
of— 
‘‘(AA) 8 percent; or 
‘‘(BB) 1.5 times the na-
tional unemployment rate; or 
‘‘(III) such individual or their de-
pendent must travel outside of their 
community for an extended period of 
time to receive medical services nec-
essary to treat a serious or complex 
medical condition (as described in 
paragraph (9)(A)(ii)(V)(ee)) that are
622 
† HR 1 EAS 
not available within their community 
of residence. 
‘‘(4) OPTION TO CONDUCT MORE FREQUENT COM-
PLIANCE VERIFICATIONS.—With respect to an appli-
cable individual enrolled and receiving medical as-
sistance under a State plan (or a waiver of such 
plan) under this title, the State shall verify (in ac-
cordance with procedures specified by the Secretary) 
that each such individual has met the requirement to 
demonstrate community engagement under paragraph 
(1) during each such individual’s regularly scheduled 
redetermination of eligibility, except that a State may 
provide for such verifications more frequently. 
‘‘(5) EX PARTE VERIFICATIONS.—For purposes of 
verifying that an applicable individual has met the 
requirement to demonstrate community engagement 
under paragraph (1), or determining such individual 
to be deemed to have demonstrated community en-
gagement under paragraph (3), or that an individual 
is a specified excluded individual under paragraph 
(9)(A)(ii), the State shall, in accordance with stand-
ards established by the Secretary, establish processes 
and use reliable information available to the State 
(such as payroll data or payments or encounter data 
under this title for individuals and data on payments
623 
† HR 1 EAS 
to such individuals for the provision of services cov-
ered under this title) without requiring, where pos-
sible, the applicable individual to submit additional 
information. 
‘‘(6) PROCEDURE IN THE CASE OF NONCOMPLI-
ANCE.— 
‘‘(A) IN GENERAL.—If a State is unable to 
verify that an applicable individual has met the 
requirement to demonstrate community engage-
ment under paragraph (1) (including, if appli-
cable, by verifying that such individual was 
deemed to have demonstrated community engage-
ment under paragraph (3)) the State shall (in 
accordance with standards specified by the Sec-
retary)— 
‘‘(i) provide such individual with the 
notice of noncompliance described in sub-
paragraph (B); 
‘‘(ii)(I) provide such individual with a 
period of 30 calendar days, beginning on 
the date on which such notice of noncompli-
ance is received by the individual, to— 
‘‘(aa) make a satisfactory showing 
to the State of compliance with such 
requirement (including, if applicable,
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† HR 1 EAS 
by showing that such individual was 
or should be deemed to have dem-
onstrated 
community 
engagement 
under paragraph (3)); or 
‘‘(bb) make a satisfactory showing 
to the State that such requirement does 
not apply to such individual on the 
basis that such individual does not 
meet the definition of applicable indi-
vidual under paragraph (9)(A); and 
‘‘(II) if such individual is enrolled 
under the State plan (or a waiver of such 
plan) under this title, continue to provide 
such individual with medical assistance 
during such 30-calendar-day period; and 
‘‘(iii) if no such satisfactory showing is 
made and the individual is not a specified 
excluded individual described in paragraph 
(9)(A)(ii), deny such individual’s applica-
tion for medical assistance under the State 
plan (or waiver of such plan) or, as appli-
cable, disenroll such individual from the 
plan (or waiver of such plan) not later than 
the end of the month following the month in
625 
† HR 1 EAS 
which such 30-calendar-day period ends, 
provided that— 
‘‘(I) the State first determines 
whether, with respect to the individual, 
there is any other basis for eligibility 
for medical assistance under the State 
plan (or waiver of such plan) or for 
another insurance affordability pro-
gram; and 
‘‘(II) the individual is provided 
written notice and granted an oppor-
tunity for a fair hearing in accordance 
with subsection (a)(3). 
‘‘(B) NOTICE.—The notice of noncompliance 
provided to an applicable individual under sub-
paragraph (A)(i) shall include information (in 
accordance with standards specified by the Sec-
retary) on— 
‘‘(i) how such individual may make a 
satisfactory showing of compliance with 
such requirement (as described in subpara-
graph (A)(ii)) or make a satisfactory show-
ing that such requirement does not apply to 
such individual on the basis that such indi-
vidual does not meet the definition of appli-
626 
† HR 1 EAS 
cable individual under paragraph (9)(A); 
and 
‘‘(ii) how such individual may reapply 
for medical assistance under the State plan 
(or a waiver of such plan) under this title 
in the case that such individuals’ applica-
tion is denied or, as applicable, in the case 
that such individual is disenrolled from the 
plan (or waiver). 
‘‘(7) TREATMENT
OF
NONCOMPLIANT
INDIVID-
UALS IN RELATION TO CERTAIN OTHER PROVISIONS.— 
‘‘(A) CERTAIN FMAP INCREASES.—A State 
shall not be treated as not providing medical as-
sistance to all individuals described in section 
1902(a)(10)(A)(i)(VIII), or as not expending 
amounts for all such individuals under the State 
plan (or waiver of such plan), solely because 
such an individual is determined ineligible for 
medical assistance under the State plan (or 
waiver) on the basis of a failure to meet the re-
quirement to demonstrate community engage-
ment under paragraph (1). 
‘‘(B) OTHER PROVISIONS.—For purposes of 
section 36B(c)(2)(B) of the Internal Revenue 
Code of 1986, an individual shall be deemed to
627 
† HR 1 EAS 
be eligible for minimum essential coverage de-
scribed in section 5000A(f)(1)(A)(ii) of such Code 
for a month if such individual would have been 
eligible for medical assistance under a State 
plan (or a waiver of such plan) under this title 
but for a failure to meet the requirement to dem-
onstrate community engagement under para-
graph (1). 
‘‘(8) OUTREACH.— 
‘‘(A) IN
GENERAL.—In accordance with 
standards specified by the Secretary, beginning 
not later than the date that precedes December 
31, 2026 (or, if the State elects under paragraph 
(1) to specify an earlier date, such earlier date) 
by the number of months specified by the State 
under paragraph (1)(A) plus 3 months, and pe-
riodically thereafter, the State shall notify appli-
cable individuals enrolled under a State plan (or 
waiver) under this title of the requirement to 
demonstrate community engagement under this 
subsection. Such notice shall include information 
on— 
‘‘(i) how to comply with such require-
ment, including an explanation of the ex-
ceptions to such requirement under para-
628 
† HR 1 EAS 
graph (3) and the definition of the term 
‘applicable individual’ under paragraph 
(9)(A); 
‘‘(ii) the consequences of noncompli-
ance with such requirement; and 
‘‘(iii) how to report to the State any 
change in the individual’s status that could 
result in— 
‘‘(I) the applicability of an excep-
tion under paragraph (3) (or the end 
of the applicability of such an excep-
tion); or 
‘‘(II) the individual qualifying as 
a specified excluded individual under 
paragraph (9)(A)(ii). 
‘‘(B) FORM OF OUTREACH NOTICE.—A no-
tice required under subparagraph (A) shall be 
delivered— 
‘‘(i) by regular mail (or, if elected by 
the individual, in an electronic format); 
and 
‘‘(ii) in 1 or more additional forms, 
which may include telephone, text message, 
an internet website, other commonly avail-
629 
† HR 1 EAS 
able electronic means, and such other forms 
as the Secretary determines appropriate. 
‘‘(9) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE INDIVIDUAL.— 
‘‘(i) IN GENERAL.—The term ‘applica-
ble individual’ means an individual (other 
than a specified excluded individual (as de-
fined in clause (ii)))— 
‘‘(I) who is eligible to enroll (or is 
enrolled) under the State plan under 
subsection (a)(10)(A)(i)(VIII); or 
‘‘(II) who— 
‘‘(aa) is otherwise eligible to 
enroll (or is enrolled) under a 
waiver of such plan that provides 
coverage that is equivalent to 
minimum essential coverage (as 
described 
in 
section 
5000A(f)(1)(A) of the Internal 
Revenue Code of 1986 and as de-
termined 
in 
accordance 
with 
standards prescribed by the Sec-
retary in regulations); and 
‘‘(bb) has attained the age of 
19 and is under 65 years of age,
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† HR 1 EAS 
is not pregnant, is not entitled to, 
or enrolled for, benefits under part 
A of title XVIII, or enrolled for 
benefits under part B of title 
XVIII, and is not otherwise eligi-
ble to enroll under such plan. 
‘‘(ii) 
SPECIFIED
EXCLUDED
INDI-
VIDUAL.—For purposes of clause (i), the 
term ‘specified excluded individual’ means 
an individual, as determined by the State 
(in accordance with standards specified by 
the Secretary)— 
‘‘(I) who is described in subsection 
(a)(10)(A)(i)(IX); 
‘‘(II) who— 
‘‘(aa) is an Indian or an 
Urban Indian (as such terms are 
defined in paragraphs (13) and 
(28) of section 4 of the Indian 
Health Care Improvement Act); 
‘‘(bb) is a California Indian 
described in section 809(a) of such 
Act; or 
‘‘(cc) has otherwise been de-
termined eligible as an Indian for
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† HR 1 EAS 
the Indian Health Service under 
regulations promulgated by the 
Secretary; 
‘‘(III) who is the parent, guard-
ian, caretaker relative, or family care-
giver (as defined in section 2 of the 
RAISE Family Caregivers Act) of a 
dependent child 13 years of age and 
under or a disabled individual; 
‘‘(IV) who is a veteran with a dis-
ability rated as total under section 
1155 of title 38, United States Code; 
‘‘(V) who is medically frail or oth-
erwise has special medical needs (as 
defined by the Secretary), including an 
individual— 
‘‘(aa) who is blind or dis-
abled (as defined in section 1614); 
‘‘(bb) with a substance use 
disorder; 
‘‘(cc) with a disabling mental 
disorder; 
‘‘(dd) with a physical, intel-
lectual or developmental disability 
that significantly impairs their
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† HR 1 EAS 
ability to perform 1 or more ac-
tivities of daily living; or 
‘‘(ee) with a serious or com-
plex medical condition; 
‘‘(VI) who— 
‘‘(aa) is in compliance with 
any requirements imposed by the 
State pursuant to section 407; or 
‘‘(bb) is a member of a house-
hold that receives supplemental 
nutrition assistance program ben-
efits under the Food and Nutri-
tion Act of 2008 and is not ex-
empt from a work requirement 
under such Act; 
‘‘(VII) who is participating in a 
drug addiction or alcoholic treatment 
and rehabilitation program (as defined 
in section 3(h) of the Food and Nutri-
tion Act of 2008); 
‘‘(VIII) who is an inmate of a 
public institution; or 
‘‘(IX) who is pregnant or entitled 
to 
postpartum 
medical 
assistance
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† HR 1 EAS 
under paragraph (5) or (16) of sub-
section (e). 
‘‘(B) EDUCATIONAL
PROGRAM.—The term 
‘educational program’ includes— 
‘‘(i) an institution of higher education 
(as defined in section 101 of the Higher 
Education Act of 1965); and 
‘‘(ii) a program of career and technical 
education (as defined in section 3 of the 
Carl D. Perkins Career and Technical Edu-
cation Act of 2006). 
‘‘(C) STATE.—The term ‘State’ means 1 of 
the 50 States or the District of Columbia. 
‘‘(D) WORK
PROGRAM.—The term ‘work 
program’ has the meaning given such term in 
section 6(o)(1) of the Food and Nutrition Act of 
2008. 
‘‘(10) PROHIBITING WAIVER OF COMMUNITY EN-
GAGEMENT REQUIREMENTS.—Notwithstanding section 
1115(a), the provisions of this subsection may not be 
waived. 
‘‘(11) SPECIAL IMPLEMENTATION RULE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), the Secretary may exempt a State
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† HR 1 EAS 
from compliance with the requirements of this 
subsection if— 
‘‘(i) the State submits to the Secretary 
a request for such exemption, made in such 
form and at such time as the Secretary may 
require, and including the information 
specified in subparagraph (B); and 
‘‘(ii) the Secretary determines that 
based on such request, the State is dem-
onstrating a good faith effort to comply 
with the requirements of this subsection. 
‘‘(B) GOOD
FAITH
EFFORT
DETERMINA-
TION.—In determining whether a State is dem-
onstrating a good faith effort for purposes of sub-
paragraph (A)(ii), the Secretary shall consider— 
‘‘(i) any actions taken by the State to-
ward compliance with the requirements of 
this subsection; 
‘‘(ii) any significant barriers to or 
challenges in meeting such requirements, in-
cluding related to funding, design, develop-
ment, procurement, or installation of nec-
essary systems or resources; 
‘‘(iii) the State’s detailed plan and 
timeline for achieving full compliance with
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† HR 1 EAS 
such requirements, including any milestones 
of such plan (as defined by the Secretary); 
and 
‘‘(iv) any other criteria determined ap-
propriate by the Secretary. 
‘‘(C) DURATION OF EXEMPTION.— 
‘‘(i) 
IN
GENERAL.—An 
exemption 
granted under subparagraph (A) shall ex-
pire not later than December 31, 2028, and 
may not be renewed beyond such date. 
‘‘(ii) EARLY TERMINATION.—The Sec-
retary may terminate an exemption granted 
under subparagraph (A) prior to the expi-
ration date of such exemption if the Sec-
retary determined that the State has— 
‘‘(I) failed to comply with the re-
porting requirements described in sub-
paragraph (D); or 
‘‘(II) based on the information 
provided pursuant to subparagraph 
(D), failed to make continued good 
faith efforts toward compliance with 
the requirements of this subsection.
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† HR 1 EAS 
‘‘(D) REPORTING REQUIREMENTS.—A State 
granted an exemption under subparagraph (A) 
shall submit to the Secretary— 
‘‘(i) quarterly progress reports on the 
State’s status in achieving the milestones to-
ward full compliance described in subpara-
graph (B)(iii); and 
‘‘(ii) information on specific risks or 
newly identified barriers or challenges to 
full compliance, including the State’s plan 
to mitigate such risks, barriers, or chal-
lenges.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)(i)(VIII)) is amended by striking 
‘‘subject to subsection (k)’’ and inserting ‘‘subject to sub-
sections (k) and (xx)’’. 
(c) PROHIBITING CONFLICTS OF INTEREST.—A State 
shall not use a Medicaid managed care entity or other speci-
fied entity (as such terms are defined in section 
1903(m)(9)(D)), or other contractor to determine bene-
ficiary compliance under such section unless the contractor 
has no direct or indirect financial relationship with any 
Medicaid managed care entity or other specified entity that 
is responsible for providing or arranging for coverage of
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† HR 1 EAS 
medical assistance for individuals enrolled with the entity 
pursuant to a contract with such State. 
(d) INTERIM FINAL RULEMAKING.—Not later than 
June 1, 2026, the Secretary of Health and Human Services 
shall promulgate an interim final rule for purposes of im-
plementing the provisions of, and the amendments made by, 
this section. Any action taken to implement the provisions 
of, and the amendments made by, this section shall not be 
subject to the provisions of section 553 of title 5, United 
States Code. 
(e) DEVELOPMENT
OF
GOVERNMENT
EFFICIENCY 
GRANTS TO STATES.— 
(1) IN GENERAL.—In order for States to estab-
lish systems necessary to carry out the provisions of, 
and amendments made by, this section or other sec-
tions of this chapter that pertain to conducting eligi-
bility determinations or redeterminations, the Sec-
retary of Health and Human Services shall— 
(A) out of amounts appropriated under 
paragraph (3)(A), award to each State a grant 
equal to the amount specified in paragraph (2) 
for such State; and 
(B) out of amounts appropriated under 
paragraph (3)(B), distribute an equal amount 
among such States.
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† HR 1 EAS 
(2) AMOUNT SPECIFIED.—For purposes of para-
graph (1)(A), the amount specified in this paragraph 
is an amount that bears the same ratio to the amount 
appropriated under paragraph (3)(A) as the number 
of applicable individuals (as defined in section 
1902(xx) of the Social Security Act, as added by sub-
section (a)) residing in such State bears to the total 
number of such individuals residing in all States, as 
of March 31, 2025. 
(3) FUNDING.—There are appropriated, out of 
any monies in the Treasury not otherwise appro-
priated— 
(A) $100,000,000 for fiscal year 2026 for 
purposes of awarding grants under paragraph 
(1)(A), to remain available until expended; and 
(B) $100,000,000 for fiscal year 2026 for 
purposes of award grants under paragraph 
(1)(B), to remain available until expended. 
(4) DEFINITION.—In this subsection, the term 
‘‘State’’ means 1 of the 50 States and the District of 
Columbia. 
(f) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
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† HR 1 EAS 
istrator of the Centers for Medicare & Medicaid Services, 
$200,000,000 for fiscal year 2026, to remain available until 
expended. 
SEC. 71120. MODIFYING COST SHARING REQUIREMENTS 
FOR 
CERTAIN 
EXPANSION 
INDIVIDUALS 
UNDER THE MEDICAID PROGRAM. 
(a) IN GENERAL.—Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by inserting ‘‘(other than, beginning 
October 1, 2028, specified individuals (as defined in 
subsection (k)(3)))’’ after ‘‘individuals’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(k) SPECIAL RULES FOR CERTAIN EXPANSION INDI-
VIDUALS.— 
‘‘(1) PREMIUMS.—Beginning October 1, 2028, 
the State plan shall provide that in the case of a spec-
ified individual (as defined in paragraph (3)) who is 
eligible under the plan, no enrollment fee, premium, 
or similar charge will be imposed under the plan. 
‘‘(2) REQUIRED
IMPOSITION
OF
COST
SHAR-
ING.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and subsection (j), in the case of a
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† HR 1 EAS 
specified individual, the State plan shall, begin-
ning October 1, 2028, provide for the imposition 
of such deductions, cost sharing, or similar 
charges determined appropriate by the State (in 
an amount greater than $0) with respect to cer-
tain care, items, or services furnished to such an 
individual, as determined by the State. 
‘‘(B) LIMITATIONS.— 
‘‘(i) EXCLUSION
OF
CERTAIN
SERV-
ICES.—In no case may a deduction, cost 
sharing, or similar charge be imposed under 
the State plan with respect to care, items, 
or services described in any of subpara-
graphs (B) through (J) of subsection (a)(2), 
or any primary care services, mental health 
care services, substance use disorder services, 
or services provided by a Federally qualified 
health center (as defined in 1905(l)(2)), cer-
tified community behavioral health clinic 
(as defined in section 1905(jj)(2)), or rural 
health clinic (as defined in 1905(l)(1)), fur-
nished to a specified individual. 
‘‘(ii) ITEM
AND
SERVICE
LIMITA-
TION.—
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† HR 1 EAS 
‘‘(I) IN GENERAL.—Except as pro-
vided in subclause (II), in no case may 
a deduction, cost sharing, or similar 
charge imposed under the State plan 
with respect to care or an item or serv-
ice furnished to a specified individual 
exceed $35. 
‘‘(II) SPECIAL RULES FOR PRE-
SCRIPTION DRUGS.—In no case may a 
deduction, cost sharing, or similar 
charge imposed under the State plan 
with respect to a prescription drug fur-
nished to a specified individual exceed 
the limit that would be applicable 
under paragraph (2)(A)(i) or (2)(B) of 
section 1916A(c) with respect to such 
drug and individual if such drug so 
furnished were subject to cost sharing 
under such section. 
‘‘(iii) MAXIMUM LIMIT ON COST SHAR-
ING.—The total aggregate amount of deduc-
tions, cost sharing, or similar charges im-
posed under the State plan for all individ-
uals in the family may not exceed 5 percent 
of the family income of the family involved,
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† HR 1 EAS 
as applied on a quarterly or monthly basis 
(as specified by the State). 
‘‘(C) CASES
OF
NONPAYMENT.—Notwith-
standing subsection (e), a State may permit a 
provider participating under the State plan to 
require, as a condition for the provision of care, 
items, or services to a specified individual enti-
tled to medical assistance under this title for 
such care, items, or services, the payment of any 
deductions, cost sharing, or similar charges au-
thorized to be imposed with respect to such care, 
items, or services. Nothing in this subparagraph 
shall be construed as preventing a provider from 
reducing or waiving the application of such de-
ductions, cost sharing, or similar charges on a 
case-by-case basis. 
‘‘(3) SPECIFIED
INDIVIDUAL
DEFINED.—For 
purposes of this subsection, the term ‘specified indi-
vidual’ means an individual who has a family in-
come (as determined in accordance with section 
1902(e)(14)) that exceeds the poverty line (as defined 
in section 2110(c)(5)) applicable to a family of the 
size involved and— 
‘‘(A) 
is 
enrolled 
under 
section 
1902(a)(10)(A)(i)(VIII); or
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† HR 1 EAS 
‘‘(B) is described in such subsection and 
otherwise enrolled under a waiver of the State 
plan that provides coverage that is equivalent to 
minimum essential coverage (as described in sec-
tion 5000A(f)(1)(A) of the Internal Revenue Code 
of 1986 and determined in accordance with 
standards prescribed by the Secretary in regula-
tions) to all individuals described in section 
1902(a)(10)(A)(i)(VIII). 
‘‘(4) STATE DEFINED.—For purposes of this sub-
section, the term ‘State’ means 1 of the 50 States or 
the District of Columbia.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) 
REQUIRED
APPLICATION.—Section 
1902(a)(14) of the Social Security Act (42 U.S.C. 
1396a(a)(14)) is amended by inserting ‘‘and provide 
for imposition of such deductions, cost sharing, or 
similar charges for care, items, or services furnished 
to specified individuals (as defined in paragraph (3) 
of section 1916(k)) in accordance with paragraph (2) 
of such section’’ after ‘‘section 1916’’. 
(2) NONAPPLICABILITY
OF
ALTERNATIVE
COST 
SHARING.—Section 1916A(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1396o–1(a)(1)) is amended, in the
644 
† HR 1 EAS 
second sentence, by striking ‘‘or (j)’’ and inserting 
‘‘(j), or (k)’’. 
(c) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services, 
$15,000,000 for fiscal year 2026, to remain available until 
expended. 
Subchapter E—Expanding Access to Care 
SEC. 71121. MAKING CERTAIN ADJUSTMENTS TO COVERAGE 
OF HOME OR COMMUNITY-BASED SERVICES 
UNDER MEDICAID. 
(a) EXPANDING HCBS COVERAGE UNDER SECTION 
1915(C) WAIVERS.—Section 1915(c) of the Social Security 
Act (42 U.S.C. 1396n(c)) is amended— 
(1) in paragraph (3), by inserting ‘‘paragraph 
(11) or’’ before ‘‘subsection (h)(2)’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(11) EXPANDING COVERAGE FOR HOME OR COMMU-
NITY-BASED SERVICES.— 
‘‘(A) IN
GENERAL.—Beginning July 1, 2028, 
notwithstanding paragraph (1), the Secretary may 
approve a waiver that is standalone from any other
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† HR 1 EAS 
waiver approved under this subsection to include as 
medical assistance under the State plan of such State 
payment for part or all of the cost of home or commu-
nity-based services (other than room and board (as 
described in paragraph (1))) approved by the Sec-
retary which are provided pursuant to a written plan 
of care to individuals described in subparagraph 
(B)(iii). A waiver approved under this paragraph 
shall be for an initial term of 3 years and, upon the 
request of the State, shall be extended for additional 
5-year periods unless the Secretary determines that 
for the previous waiver period the requirements speci-
fied under this subsection (excluding those excepted 
under subparagraph (B)) have not been met. 
‘‘(B) STATE REQUIREMENTS.—In addition to the 
requirements specified under this subsection (except 
for the requirements described in subparagraphs (C) 
and (D) of paragraph (2) and any other requirement 
specified under this subsection that the Secretary de-
termines to be inapplicable in the context of a waiver 
that does not require individuals to have a determina-
tion described in paragraph (1)), a State shall meet 
the following requirements as a condition of waiver 
approval:
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† HR 1 EAS 
‘‘(i) As of the date that such State requests 
a waiver under this subsection to provide home 
or community-based services to individuals de-
scribed in clause (iii), all other waivers (if any) 
granted under this subsection to such State meet 
the requirements of this subsection. 
‘‘(ii) The State demonstrates to the Sec-
retary that approval of a waiver under this sub-
section with respect to individuals described in 
clause (iii) will not result in a material increase 
of the average amount of time that individuals 
with respect to whom a determination described 
in paragraph (1) has been made will need to 
wait to receive home or community-based serv-
ices under any other waiver granted under this 
subsection, as determined by the Secretary. 
‘‘(iii) The State establishes needs-based cri-
teria, subject to the approval of the Secretary, re-
garding who will be eligible for home or commu-
nity-based services under a waiver approved 
under this paragraph without requiring such in-
dividuals to have a determination described in 
paragraph (1), and specifies the home or commu-
nity-based services such individuals so eligible 
will receive.
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† HR 1 EAS 
‘‘(iv) The State establishes needs-based cri-
teria for determining whether an individual de-
scribed in clause (iii) requires the level of care 
provided in a hospital, nursing facility, or an 
intermediate care facility for individuals with 
developmental disabilities under the State plan 
or under any waiver of such plan that are more 
stringent than the needs-based criteria estab-
lished under clause (iii) for determining eligi-
bility for home or community-based services. 
‘‘(v) The State attests that the State’s aver-
age per capita expenditure for medical assistance 
under the State plan (or waiver of such plan) 
provided with respect to such individuals en-
rolled in a waiver under this paragraph will not 
exceed the State’s average per capita expenditure 
for medical assistance for individuals receiving 
institutional care under the State plan (or waiv-
er of such plan) for the duration that the waiver 
under this paragraph is in effect. 
‘‘(vi) The State provides to the Secretary 
data (in such form and manner as the Secretary 
may specify) regarding the number of individ-
uals described in clause (iii) with respect to a 
State seeking approval of a waiver under this
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† HR 1 EAS 
subsection, to whom the State will make such 
services available under such waiver. 
‘‘(vii) The State agrees to provide to the 
Secretary, not less frequently than annually, 
data for purposes of paragraph (2)(E) (in such 
form and manner as the Secretary may specify) 
regarding, with respect to each preceding year in 
which a waiver under this subsection to provide 
home or community-based services to individuals 
described in clause (iii) was in effect— 
‘‘(I) the cost (as such term is defined 
by the Secretary) of such services furnished 
to individuals described in clause (iii), bro-
ken down by type of service; 
‘‘(II) with respect to each type of home 
or community-based service provided under 
the waiver, the length of time that such in-
dividuals have received such service; 
‘‘(III) a comparison between the data 
described in subclause (I) and any com-
parable data available with respect to indi-
viduals with respect to whom a determina-
tion described in paragraph (1) has been 
made and with respect to individuals re-
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† HR 1 EAS 
ceiving institutional care under this title; 
and 
‘‘(IV) the number of individuals who 
have received home or community-based 
services under the waiver during the pre-
ceding year. 
‘‘(C) LIMITATION ON PAYMENTS.—No payments 
made to carry out this paragraph shall be used by a 
State to make payments to a third party on behalf of 
an individual practitioner for benefits such as health 
insurance, skills training, and other benefits cus-
tomary for employees, in the case of a class of practi-
tioners for which the program established under this 
title is the primary source of revenue.’’. 
(b) IMPLEMENTATION FUNDING.— 
(1) IN GENERAL.—There are appropriated, out 
of any monies in the Treasury not otherwise appro-
priated, to the Administrator of the Centers for Medi-
care & Medicaid Services— 
(A) for fiscal year 2026, $50,000,000 for 
purposes of carrying out the provisions of, and 
the amendments made by, this section, to remain 
available until expended; and 
(B) for fiscal year 2027, $100,000,000 for 
purposes of making payments to States, subject
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† HR 1 EAS 
to paragraph (2), to support State systems to de-
liver home or community-based services under 
section 1915(c) of the Social Security Act (42 
U.S.C. 1396n(c)) (as amended by this section) or 
under section 1115 of such Act (42 U.S.C. 1315), 
to remain available until expended. 
(2) PAYMENTS BASED ON STATE HCBS ELIGIBLE 
POPULATION.—Payments to States from amounts 
made available by paragraph (1)(B) shall be made, 
with respect to a State, on the basis of the proportion 
of the population of the State that is receiving home 
or community-based services under section1915(c) of 
the Social Security Act (42 U.S.C. 1396n(c)) (as 
amended by this section) or under section 1115 of 
such Act (42 U.S.C. 1315), as compared to all States. 
CHAPTER 2—MEDICARE 
Subchapter A—Strengthening Eligibility 
Requirements 
SEC. 71201. LIMITING MEDICARE COVERAGE OF CERTAIN 
INDIVIDUALS. 
Title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) is amended by adding at the end the following new 
section:
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† HR 1 EAS 
‘‘SEC. 1899C. LIMITING MEDICARE COVERAGE OF CERTAIN 
INDIVIDUALS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), an indi-
vidual may be entitled to, or enrolled for, benefits under 
this title only if the individual is— 
‘‘(1) a citizen or national of the United States; 
‘‘(2) an alien who is lawfully admitted for per-
manent residence under the Immigration and Nation-
ality Act; 
‘‘(3) an alien who has been granted the status of 
Cuban and Haitian entrant, as defined in section 
501(e) of the Refugee Education Assistance Act of 
1980 (Public Law 96–422); or 
‘‘(4) an individual who lawfully resides in the 
United States in accordance with a Compact of Free 
Association referred to in section 402(b)(2)(G) of the 
Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996. 
‘‘(b) APPLICATION TO INDIVIDUALS CURRENTLY ENTI-
TLED TO OR ENROLLED FOR BENEFITS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
who is entitled to, or enrolled for, benefits under this 
title as of the date of the enactment of this section, 
subsection (a) shall apply beginning on the date that 
is 18 months after such date of enactment.
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† HR 1 EAS 
‘‘(2) REVIEW BY COMMISSIONER OF SOCIAL SE-
CURITY.— 
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of the enactment of this section, the 
Commissioner of Social Security shall complete a 
review of individuals entitled to, or enrolled for, 
benefits under this title as of such date of enact-
ment for purposes of identifying individuals not 
described in any of paragraphs (1) through (4) 
of subsection (a). 
‘‘(B) NOTICE.—The Commissioner of Social 
Security shall notify each individual identified 
under the review conducted under subparagraph 
(A) that such individual’s entitlement to, or en-
rollment for, benefits under this title will be ter-
minated as of the date that is 18 months after 
the date of the enactment of this section. Such 
notification shall be made as soon as practicable 
after such identification and in a manner de-
signed to ensure such individual’s comprehension 
of such notification.’’.
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† HR 1 EAS 
Subchapter B—Improving Services for Seniors 
SEC. 71202. TEMPORARY PAYMENT INCREASE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE TO AC-
COUNT FOR EXCEPTIONAL CIRCUMSTANCES. 
(a) IN GENERAL.—Section 1848(t) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(t)) is amended— 
(1) in the subsection heading, by striking ‘‘DUR-
ING 2021 THROUGH 2024’’; 
(2) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘and 2024’’ and inserting 
‘‘2024, and 2026’’; 
(B) in subparagraph (D), by striking ‘‘and’’ 
at the end; 
(C) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(F) such services furnished on or after 
January 1, 2026, and before January 1, 2027, 
by 2.5 percent.’’; and 
(3) in paragraph (2)(C)— 
(A) in the subparagraph heading, by insert-
ing ‘‘AND 2026’’ after ‘‘2024’’; and
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† HR 1 EAS 
(B) by striking ‘‘or 2024’’ each place it ap-
pears and inserting ‘‘2024, or 2026’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1848(c)(2)(B)(iv)(V) of the Social Security Act (42 U.S.C. 
1395w–4(c)(2)(B)(iv)(V)) is amended by striking ‘‘or 2024’’ 
and inserting ‘‘2024, or 2026’’. 
SEC. 71203. EXPANDING AND CLARIFYING THE EXCLUSION 
FOR ORPHAN DRUGS UNDER THE DRUG 
PRICE NEGOTIATION PROGRAM. 
(a) IN GENERAL.—Section 1192(e) of the Social Secu-
rity Act (42 U.S.C. 1320f–1(e)) is amended— 
(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘and (3)’’ and insert-
ing ‘‘through (4)’’; 
(2) in paragraph (3)(A)— 
(A) by striking ‘‘only one rare disease or 
condition’’ and inserting ‘‘one or more rare dis-
eases or conditions’’; and 
(B) by striking ‘‘such disease or condition’’ 
and inserting ‘‘one or more such rare diseases or 
conditions (as such term is defined in section 
526(a)(2) of the Federal Food, Drug, and Cos-
metic Act)’’; and 
(3) by adding at the end the following new para-
graph:
655 
† HR 1 EAS 
‘‘(4) TREATMENT OF FORMER ORPHAN DRUGS.— 
In the case of a drug or biological product that, as 
of the date of the approval or licensure of such drug 
or biological product, is a drug or biological product 
described in paragraph (3)(A), paragraph (1)(A)(ii) 
or (1)(B)(ii) (as applicable) shall apply as if the ref-
erence to ‘the date of such approval’ or ‘the date of 
such licensure’, respectively, were instead a reference 
to ‘the first day after the date of such approval for 
which such drug is not a drug described in paragraph 
(3)(A)’ or ‘the first day after the date of such licen-
sure for which such biological product is not a bio-
logical product described in paragraph (3)(A)’, re-
spectively.’’. 
(b) APPLICATION.—The amendments made by sub-
section (a) shall apply with respect to initial price applica-
bility years (as defined in section 1191(b) of the Social Se-
curity Act (42 U.S.C. 1320f(b))) beginning on or after Jan-
uary 1, 2028. 
CHAPTER 3—HEALTH TAX 
Subchapter A—Improving Eligibility Criteria 
SEC. 71301. PERMITTING PREMIUM TAX CREDIT ONLY FOR 
CERTAIN INDIVIDUALS. 
(a) IN GENERAL.—Section 36B(e)(1) is amended by 
inserting ‘‘or, in the case of aliens who are lawfully present,
656 
† HR 1 EAS 
are not eligible aliens’’ after ‘‘individuals who are not law-
fully present’’. 
(b) ELIGIBLE ALIENS.—Section 36B(e)(2) is amend-
ed— 
(1) by striking ‘‘For purposes of this section, an 
individual’’ and inserting ‘‘For purposes of this sec-
tion— 
‘‘(A) IN GENERAL.—An individual’’, and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) ELIGIBLE
ALIENS.—An individual 
who is an alien and lawfully present shall be 
treated as an eligible alien if such individual is, 
and is reasonably expected to be for the entire 
period of enrollment for which the credit under 
this section is being claimed— 
‘‘(i) an alien who is lawfully admitted 
for permanent residence under the Immi-
gration and Nationality Act (8 U.S.C. 1101 
et seq.), 
‘‘(ii) an alien who has been granted the 
status of Cuban and Haitian entrant, as 
defined in section 501(e) of the Refugee 
Education Assistance Act of 1980 (Public 
Law 96–422); or
657 
† HR 1 EAS 
‘‘(iii) an individual who lawfully re-
sides in the United States in accordance 
with a Compact of Free Association referred 
to in section 402(b)(2)(G) of the Personal 
Responsibility and Work Opportunity Rec-
onciliation 
Act 
of 
1996 
(8 
U.S.C. 
1612(b)(2)(G)).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) VERIFICATION
OF
INFORMATION.—Section 
1411 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18081) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking ‘‘and 
section 36B(e) of the Internal Revenue Code 
of 1986’’; and 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by strik-
ing ‘‘and’’ at the end; 
(II) in subparagraph (B), by add-
ing ‘‘and’’ at the end; and 
(III) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) in the case such individual is an alien 
lawfully present in the United States, whether
658 
† HR 1 EAS 
such individual is an eligible alien (within the 
meaning of section 36B(e)(2) of such Code);’’; 
(B) in subsection (b)(3), by adding at the 
end the following new subparagraph: 
‘‘(D) IMMIGRATION
STATUS.—In the case 
the individual’s eligibility is based on an attesta-
tion of the enrollee’s immigration status, an at-
testation that such individual is an eligible alien 
(within the meaning of 36B(e)(2) of the Internal 
Revenue Code of 1986).’’; and 
(C) in subsection (c)(2)(B)(ii), by adding at 
the end the following new subclause: 
‘‘(III) In the case of an individual 
described in clause (i)(I) with respect 
to whom a premium tax credit under 
section 36B of the Internal Revenue 
Code of 1986 is being claimed, the at-
testation that the individual is an eli-
gible alien (within the meaning of sec-
tion 36B(e)(2) of such Code).’’. 
(2) 
ADVANCE
DETERMINATIONS.—Section 
1412(d) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18082(d)) is amended by inserting be-
fore the period at the end the following: ‘‘, or credits 
under section 36B of the Internal Revenue Code of
659 
† HR 1 EAS 
1986 for aliens who are not eligible aliens (within the 
meaning of section 36B(e)(2) of such Code)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2027. 
(d) REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL 
COVERAGE.—Section 5000A(d)(3) is amended by striking 
‘‘an alien lawfully present in the United States’’ and insert-
ing ‘‘an eligible alien (within the meaning of section 
36B(e)(2))’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section (other than the amendments made by subsection (c)) 
shall apply to taxable years beginning after December 31, 
2026. 
SEC. 71302. DISALLOWING PREMIUM TAX CREDIT DURING 
PERIODS OF MEDICAID INELIGIBILITY DUE 
TO ALIEN STATUS. 
(a) IN GENERAL.—Section 36B(c)(1) is amended by 
striking subparagraph (B). 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2025.
660 
† HR 1 EAS 
Subchapter B—Preventing Waste, Fraud, and 
Abuse 
SEC. 71303. REQUIRING VERIFICATION OF ELIGIBILITY FOR 
PREMIUM TAX CREDIT. 
(a) IN GENERAL.—Section 36B(c) is amended by add-
ing at the end the following new paragraphs: 
‘‘(5) EXCHANGE ENROLLMENT VERIFICATION RE-
QUIREMENT.— 
‘‘(A) IN
GENERAL.—The term ‘coverage 
month’ shall not include, with respect to any in-
dividual covered by a qualified health plan en-
rolled in through an Exchange, any month be-
ginning before the Exchange verifies, using ap-
plicable enrollment information that shall be 
provided or verified by the applicant, such indi-
vidual’s eligibility— 
‘‘(i) to enroll in the plan through the 
Exchange, and 
‘‘(ii) for any advance payment under 
section 1412 of the Patient Protection and 
Affordable Care Act of the credit allowed 
under this section. 
‘‘(B) APPLICABLE
ENROLLMENT
INFORMA-
TION.—For purposes of subparagraph (A), appli-
cable enrollment information shall include affir-
661 
† HR 1 EAS 
mation of at least the following information (to 
the extent relevant in determining eligibility de-
scribed in subparagraph (A)): 
‘‘(i) Household income and family size. 
‘‘(ii) Whether the individual is an eli-
gible alien. 
‘‘(iii) Any health coverage status or eli-
gibility for coverage. 
‘‘(iv) Place of residence. 
‘‘(v) Such other information as may be 
determined by the Secretary (in consulta-
tion with the Secretary of Health and 
Human Services) as necessary to the 
verification prescribed under subparagraph 
(A). 
‘‘(C) VERIFICATION OF PAST MONTHS.—In 
the case of a month that begins before 
verification prescribed by subparagraph (A), 
such month shall be treated as a coverage month 
if the Exchange verifies for such month (using 
applicable enrollment information that shall be 
provided or verified by the applicant) such indi-
vidual’s eligibility to have so enrolled and for 
any such advance payment.
662 
† HR 1 EAS 
‘‘(D) EXCHANGE PARTICIPATION; COORDINA-
TION
WITH
OTHER
PROCEDURES
FOR
DETER-
MINING ELIGIBILITY.—An individual shall not, 
solely by reason of failing to meet the require-
ments of this paragraph with respect to a month, 
be treated for such month as ineligible to enroll 
in a qualified health plan through an Exchange. 
‘‘(E) WAIVER
FOR
CERTAIN
SPECIAL
EN-
ROLLMENT PERIODS.—The Secretary may waive 
the application of subparagraph (A) in the case 
of an individual who enrolls in a qualified 
health plan through an Exchange for 1 or more 
months of the taxable year during a special en-
rollment period provided by the Exchange on the 
basis of a change in the family size of the indi-
vidual. 
‘‘(F) INFORMATION
AND
RELIANCE
ON 
THIRD-PARTY SOURCES.—An Exchange shall be 
permitted to use any data available to the Ex-
change and any reliable third-party sources in 
collecting information for verification by the ap-
plicant. 
‘‘(6) EXCHANGE COMPLIANCE WITH FILING RE-
QUIREMENTS.—The term ‘coverage month’ shall not 
include, with respect to any individual covered by a
663 
† HR 1 EAS 
qualified health plan enrolled in through an Ex-
change, any month for which the Exchange does not 
meet the requirements of section 155.305(f)(4)(iii) of 
title 45, Code of Federal Regulations (as published in 
the Federal Register on June 25, 2025 (90 Fed. Reg. 
27074), applied as though it applied to all plan years 
after 2025), with respect to the individual.’’. 
(b) PRE-ENROLLMENT VERIFICATION PROCESS RE-
QUIRED.—Section 36B(c)(3)(A) is amended— 
(1) by striking ‘‘HEALTH PLAN.—The term’’ and 
inserting ‘‘HEALTH PLAN.— ‘‘ 
‘‘(i) IN GENERAL.—The term’’, and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) PRE-ENROLLMENT VERIFICATION 
PROCESS REQUIRED.—Such term shall not 
include any plan enrolled in through an 
Exchange, unless such Exchange provides a 
process 
for 
pre-enrollment 
verification 
through which any applicant may, begin-
ning not later than August 1, verify with 
the Exchange the applicant’s household in-
come and eligibility for enrollment in such 
plan for plan years beginning in the subse-
quent year.’’.
664 
† HR 1 EAS 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2027. 
SEC. 71304. DISALLOWING PREMIUM TAX CREDIT IN CASE 
OF CERTAIN COVERAGE ENROLLED IN DUR-
ING SPECIAL ENROLLMENT PERIOD. 
(a) IN GENERAL.—Section 36B(c)(3)(A), as amended 
by the preceding provisions of this Act, is amended by add-
ing at the end the following new clause: 
‘‘(iii) EXCEPTION IN CASE OF CERTAIN 
SPECIAL
ENROLLMENT
PERIODS.—Such 
term shall not include any plan enrolled in 
during a special enrollment period provided 
for by an Exchange— 
‘‘(I) on the basis of the relation-
ship of the individual’s expected house-
hold income to such a percentage of the 
poverty line (or such other amount) as 
is prescribed by the Secretary of 
Health and Human Services for pur-
poses of such period, and 
‘‘(II) not in connection with the 
occurrence of an event or change in 
circumstances specified by the Sec-
665 
† HR 1 EAS 
retary of Health and Human Services 
for such purposes.’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to plan years beginning 
after December 31, 2025. 
SEC. 71305. ELIMINATING LIMITATION ON RECAPTURE OF 
ADVANCE PAYMENT OF PREMIUM TAX CRED-
IT. 
(a) IN GENERAL.—Section 36B(f)(2) is amended by 
striking subparagraph (B). 
(b) CONFORMING AMENDMENTS.— 
(1) Section 36B(f)(2) is amended by striking 
‘‘ADVANCE PAYMENTS.—’’ and all that follows through 
‘‘If the advance payments’’ and inserting the fol-
lowing: ‘‘ADVANCE PAYMENTS.—If the advance pay-
ments’’. 
(2) Section 35(g)(12)(B)(ii) is amended by strik-
ing ‘‘then section 36B(f)(2)(B) shall be applied by 
substituting the amount determined under clause (i) 
for 
the 
amount 
determined 
under 
section 
36B(f)(2)(A)’’ and inserting ‘‘then the amount deter-
mined under clause (i) shall be substituted for the 
amount determined under section 36B(f)(2)’’.
666 
† HR 1 EAS 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2025. 
Subchapter C—Enhancing Choice for Patients 
SEC. 71306. PERMANENT EXTENSION OF SAFE HARBOR FOR 
ABSENCE OF DEDUCTIBLE FOR TELEHEALTH 
SERVICES. 
(a) IN
GENERAL.—Subparagraph (E) of section 
223(c)(2) is amended to read as follows: 
‘‘(E) SAFE HARBOR FOR ABSENCE OF DE-
DUCTIBLE FOR TELEHEALTH.—A plan shall not 
fail to be treated as a high deductible health plan 
by reason of failing to have a deductible for tele-
health and other remote care services.’’. 
(b) CERTAIN COVERAGE DISREGARDED.—Clause (ii) 
of section 223(c)(1)(B) is amended by striking ‘‘(in the case 
of months or plan years to which paragraph (2)(E) ap-
plies)’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to plan years beginning after December 
31, 2024.
667 
† HR 1 EAS 
SEC. 71307. ALLOWANCE OF BRONZE AND CATASTROPHIC 
PLANS IN CONNECTION WITH HEALTH SAV-
INGS ACCOUNTS. 
(a) IN GENERAL.—Section 223(c)(2) is amended by 
adding at the end the following new subparagraph: 
‘‘(H) BRONZE
AND
CATASTROPHIC
PLANS 
TREATED
AS
HIGH
DEDUCTIBLE
HEALTH 
PLANS.—The term ‘high deductible health plan’ 
shall include any plan which is— 
‘‘(i) available as individual coverage 
through an Exchange established under sec-
tion 1311 or 1321 of the Patient Protection 
and Affordable Care Act, and 
‘‘(ii) described in subsection (d)(1)(A) 
or (e) of section 1302 of such Act.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to months beginning after December 31, 
2025. 
SEC. 71308. TREATMENT OF DIRECT PRIMARY CARE SERV-
ICE ARRANGEMENTS. 
(a) IN GENERAL.—Section 223(c)(1) is amended by 
adding at the end the following new subparagraph: 
‘‘(E) TREATMENT
OF
DIRECT
PRIMARY 
CARE SERVICE ARRANGEMENTS.— 
‘‘(i) IN GENERAL.—A direct primary 
care service arrangement shall not be treat-
668 
† HR 1 EAS 
ed as a health plan for purposes of subpara-
graph (A)(ii). 
‘‘(ii) DIRECT PRIMARY CARE SERVICE 
ARRANGEMENT.—For purposes of this sub-
paragraph— 
‘‘(I) IN GENERAL.—The term ‘di-
rect primary care service arrangement’ 
means, with respect to any individual, 
an arrangement under which such in-
dividual is provided medical care (as 
defined in section 213(d)) consisting 
solely of primary care services pro-
vided by primary care practitioners 
(as defined in section 1833(x)(2)(A) of 
the Social Security Act, determined 
without regard to clause (ii) thereof), if 
the sole compensation for such care is 
a fixed periodic fee. 
‘‘(II) LIMITATION.—With respect 
to any individual for any month, such 
term shall not include any arrange-
ment if the aggregate fees for all direct 
primary care service arrangements (de-
termined without regard to this sub-
clause) with respect to such individual
669 
† HR 1 EAS 
for such month exceed $150 (twice such 
dollar amount in the case of an indi-
vidual with any direct primary care 
service arrangement (as so determined) 
that covers more than one individual). 
‘‘(iii) CERTAIN
SERVICES
SPECIFI-
CALLY
EXCLUDED
FROM
TREATMENT
AS 
PRIMARY CARE SERVICES.—For purposes of 
this subparagraph, the term ‘primary care 
services’ shall not include— 
‘‘(I) procedures that require the 
use of general anesthesia, 
‘‘(II) prescription drugs (other 
than vaccines), and 
‘‘(III) 
laboratory 
services 
not 
typically administered in an ambula-
tory primary care setting. 
The Secretary, after consultation with the 
Secretary of Health and Human Services, 
shall issue regulations or other guidance re-
garding the application of this clause.’’. 
(b) DIRECT PRIMARY CARE SERVICE ARRANGEMENT 
FEES
TREATED
AS
MEDICAL
EXPENSES.—Section 
223(d)(2)(C) is amended by striking ‘‘or’’ at the end of 
clause (iii), by striking the period at the end of clause (iv)
670 
† HR 1 EAS 
and inserting ‘‘, or’’, and by adding at the end the following 
new clause: 
‘‘(v) any direct primary care service 
arrangement.’’. 
(c) INFLATION ADJUSTMENT.—Section 223(g)(1) is 
amended— 
(1) by striking ‘‘in subsections (b)(2) and 
(c)(2)(A)’’ and inserting ‘‘in subsections (b)(2), 
(c)(2)(A), and in the case of taxable years beginning 
after 2026, (c)(1)(E)(ii)(II)’’, 
(2) in subparagraph (B), by striking ‘‘clause 
(ii)’’ in clause (i) and inserting ‘‘clauses (ii) and 
(iii)’’, by striking ‘‘and’’ at the end of clause (i), by 
striking the period at the end of clause (ii) and in-
serting ‘‘, and’’, and by inserting after clause (ii) the 
following new clause: 
‘‘(iii) in the case of the dollar amount 
in subsection (c)(1)(E)(ii)(II), ‘calendar 
year 2025’.’’, and 
(3) by inserting ‘‘, (c)(1)(E)(ii)(II),’’ after 
‘‘(b)(2)’’ in the last sentence. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to months beginning after December 31, 
2025.
671 
† HR 1 EAS 
CHAPTER 4—PROTECTING RURAL 
HOSPITALS AND PROVIDERS 
SEC. 71401. RURAL HEALTH TRANSFORMATION PROGRAM. 
(a) IN GENERAL.—Section 2105 of the Social Security 
Act (42 U.S.C. 1397ee) is amended by adding at the end 
the following new subsection: 
‘‘(h) RURAL HEALTH TRANSFORMATION PROGRAM.— 
‘‘(1) APPROPRIATION.— 
‘‘(A) IN
GENERAL.—There are appro-
priated, out of any money in the Treasury not 
otherwise appropriated, to the Administrator of 
the Centers for Medicare & Medicaid Services (in 
this subsection referred to as the ‘Adminis-
trator’), to provide allotments to States for pur-
poses of carrying out the activities described in 
paragraph (6)— 
‘‘(i) $10,000,000,000 for fiscal year 
2026; 
‘‘(ii) $10,000,000,000 for fiscal year 
2027; 
‘‘(iii) $10,000,000,000 for fiscal year 
2028; 
‘‘(iv) $10,000,000,000 for fiscal year 
2029; and
672 
† HR 1 EAS 
‘‘(v) $10,000,000,000 for fiscal year 
2030. 
‘‘(B) 
UNEXPENDED
OR
UNOBLIGATED 
FUNDS.— 
‘‘(i) IN GENERAL.—Any amounts ap-
propriated under subparagraph (A) that are 
unexpended or unobligated as of October 1, 
2032, shall be returned to the Treasury of 
the United States. 
‘‘(ii) 
REDISTRIBUTION
OF
UNEX-
PENDED OR UNOBLIGATED FUNDS.—In car-
rying out subparagraph (A), the Adminis-
trator shall, not later than March 31, 2028, 
and annually thereafter through March 31, 
2032, determine the amount of funds, if 
any, that are available under such subpara-
graph for a previous fiscal year, are unex-
pended or unobligated with respect to such 
fiscal year, and will not be available to a 
State in the current fiscal year, pursuant to 
clause (iii). 
‘‘(iii) AVAILABILITY OF FUNDS.— 
‘‘(I) IN
GENERAL.—Amounts al-
lotted to a State under this subsection 
for a year shall be available for ex-
673 
† HR 1 EAS 
penditure by the State through the end 
of the fiscal year following the fiscal 
year in which such amounts are allot-
ted. 
‘‘(II) AVAILABILITY OF AMOUNTS 
REDISTRIBUTED.—Amounts redistrib-
uted to a State under clause (ii) with 
respect to a fiscal year shall be avail-
able for expenditure by the State 
through the end of the fiscal year fol-
lowing the fiscal year in which such 
amounts are redistributed (except in 
the case of amounts redistributed in 
fiscal year 2032 which shall only be 
available for expenditure through Sep-
tember 30, 2032). 
‘‘(iv) MISUSE OF FUNDS.—If the Ad-
ministrator determines that a State is not 
using amounts allotted or redistributed to 
the State under this subsection in a manner 
consistent with the description provided by 
the State in its application approved under 
paragraph (2), the Administrator may 
withhold payments to, or reduce payments 
to, or recover previous payments from, the
674 
† HR 1 EAS 
State under this subsection as the Adminis-
trator deems appropriate, and any amounts 
so withheld, or that remain after any such 
reduction, or so recovered, shall be returned 
to the Treasury of the United States. 
‘‘(2) APPLICATION.— 
‘‘(A) IN GENERAL.—To be eligible for an al-
lotment under this subsection, a State shall sub-
mit to the Administrator during an application 
submission period to be specified by the Admin-
istrator (but that ends not later than December 
31, 2025) an application in such form and man-
ner as the Administrator may specify, that in-
cludes— 
‘‘(i) a detailed rural health trans-
formation plan— 
‘‘(I) to improve access to hos-
pitals, other health care providers, and 
health care items and services fur-
nished to rural residents of the State; 
‘‘(II) to improve health care out-
comes of rural residents of the State; 
‘‘(III) to prioritize the use of new 
and emerging technologies that empha-
675 
† HR 1 EAS 
size prevention and chronic disease 
management; 
‘‘(IV) to initiate, foster, and 
strengthen local and regional strategic 
partnerships between rural hospitals 
and other health care providers in 
order to promote measurable quality 
improvement, increase financial sta-
bility, maximize economies of scale, 
and share best practices in care deliv-
ery; 
‘‘(V) to enhance economic oppor-
tunity for, and the supply of, health 
care clinicians through enhanced re-
cruitment and training; 
‘‘(VI) to prioritize data and tech-
nology driven solutions that help rural 
hospitals and other rural health care 
providers furnish high-quality health 
care services as close to a patient’s 
home as is possible; 
‘‘(VII) that outlines strategies to 
manage long-term financial solvency 
and operating models of rural hos-
pitals in the State; and
676 
† HR 1 EAS 
‘‘(VIII) that identifies specific 
causes driving the accelerating rate of 
stand-alone rural hospitals becoming 
at risk of closure, conversion, or service 
reduction; 
‘‘(ii) a certification that none of the 
amounts provided under this subsection 
shall be used by the State for an expendi-
ture that is attributable to an intergovern-
mental transfer, certified public expendi-
ture, or any other expenditure to finance 
the non-Federal share of expenditures re-
quired under any provision of law, includ-
ing under the State plan established under 
this title, the State plan established under 
title XIX, or under a waiver of such plans; 
and 
‘‘(iii) such other information as the 
Administrator may require. 
‘‘(B) DEADLINE FOR APPROVAL.—Not later 
than December 31, 2025, the Administrator shall 
approve or deny all applications submitted for 
an allotment under this subsection. 
‘‘(C) ONE-TIME APPLICATION.—If an appli-
cation of a State for an allotment under this
677 
† HR 1 EAS 
subsection is approved by the Administrator, the 
State shall be eligible for an allotment under this 
subsection for each of fiscal years 2026 through 
2030, 
except 
as 
provided 
in 
paragraph 
(1)(B)(iv). 
‘‘(D) ELIGIBILITY.—Only the 50 States 
shall be eligible for an allotment under this sub-
section and all references in this subsection to a 
State shall be treated as only referring to the 50 
States. 
‘‘(3) ALLOTMENTS.— 
‘‘(A) IN GENERAL.—For each of fiscal years 
2026 through 2030, the Administrator shall de-
termine under subparagraph (B) the amount of 
the allotment for such fiscal year for each State 
with an approved application under this sub-
section. 
‘‘(B) AMOUNT
DETERMINED.—Subject to 
subparagraph (C), from the amounts appro-
priated under paragraph (1)(A) for each of fiscal 
years 2026 through 2030, the Administrator 
shall allot— 
‘‘(i) 50 percent of the amounts appro-
priated for each such fiscal year equally
678 
† HR 1 EAS 
among all States with an approved applica-
tion under this subsection; and 
‘‘(ii) 50 percent of the amounts appro-
priated for each such fiscal year among all 
such States in an amount to be determined 
by the Administrator in accordance with 
subparagraph (C). 
‘‘(C) REQUIREMENTS.—In determining the 
amount to be allotted to a State under clause (ii) 
of subparagraph (B) for a fiscal year, the Ad-
ministrator shall— 
‘‘(i) ensure that not less than 1⁄4 of the 
States with an approved application under 
this subsection for a fiscal year are allotted 
funds from amounts that are to be allotted 
under clause (ii) of such subparagraph; and 
‘‘(ii) consider— 
‘‘(I) the percentage of the State 
population that is located in a rural 
census tract of a metropolitan statis-
tical area (as determined under the 
most recent modification of the Gold-
smith Modification, originally pub-
lished in the Federal Register on Feb-
ruary 27, 1992 (57 Fed. Reg. 6725));
679 
† HR 1 EAS 
‘‘(II) the proportion of rural 
health facilities (as defined in subpara-
graph (D)) in the State relative to the 
number of rural health facilities na-
tionwide; 
‘‘(III) the situation of hospitals in 
the State, as described in section 
1902(a)(13)(A)(iv); and 
‘‘(IV) any other factors that the 
Administrator determines appropriate. 
‘‘(D) RURAL HEALTH FACILITY DEFINED.— 
For the purposes of subparagraph (C)(ii), the 
term ‘rural health facility’ means the following: 
‘‘(i) A subsection (d) hospital (as de-
fined in paragraph (1)(B) of section 
1886(d)) that— 
‘‘(I) is located in a rural area (as 
defined in paragraph (2)(D) of such 
section); 
‘‘(II) is treated as being located in 
a rural area pursuant to paragraph 
(8)(E) of such section; or 
‘‘(III) is located in a rural census 
tract of a metropolitan statistical area 
(as determined under the most recent
680 
† HR 1 EAS 
modification of the Goldsmith Modi-
fication, originally published in the 
Federal Register on February 27, 1992 
(57 Fed. Reg. 6725)). 
‘‘(ii) A critical access hospital (as de-
fined in section 1861(mm)(1)). 
‘‘(iii) A sole community hospital (as 
defined in section 1886(d)(5)(D)(iii)). 
‘‘(iv) A Medicare-dependent, small 
rural hospital (as defined in section 
1886(d)(5)(G)(iv)). 
‘‘(v) A low-volume hospital (as defined 
in section 1886(d)(12)(C)). 
‘‘(vi) A rural emergency hospital (as 
defined in section 1861(kkk)(2)). 
‘‘(vii) A rural health clinic (as defined 
in section 1861(aa)(2)). 
‘‘(viii) A Federally qualified health 
center (as defined in section 1861(aa)(4)). 
‘‘(ix) A community mental health cen-
ter (as defined in section 1861(ff)(3)(B)). 
‘‘(x) A health center that is receiving a 
grant under section 330 of the Public 
Health Service Act.
681 
† HR 1 EAS 
‘‘(xi) An opioid treatment program (as 
defined in section 1861(jjj)(2)) that is lo-
cated in a rural census tract of a metropoli-
tan statistical area (as determined under 
the most recent modification of the Gold-
smith Modification, originally published in 
the Federal Register on February 27, 1992 
(57 Fed. Reg. 6725)). 
‘‘(xii) A certified community behav-
ioral health clinic (as defined in section 
1905(jj)(2)) that is located in a rural census 
tract of a metropolitan statistical area (as 
determined under the most recent modifica-
tion of the Goldsmith Modification, origi-
nally published in the Federal Register on 
February 27, 1992 (57 Fed. Reg. 6725)). 
‘‘(4) NO MATCHING PAYMENT.—A State approved 
for an allotment under this subsection for a fiscal 
year shall not be required to provide any matching 
funds as a condition for receiving payments from the 
allotment. 
‘‘(5) TERMS
AND
CONDITIONS.—The Adminis-
trator shall specify such terms and conditions for al-
lotments to States provided under this subsection as
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† HR 1 EAS 
the Administrator deems appropriate, including the 
following: 
‘‘(A) Each State shall submit to the Admin-
istrator (at a time, and in a form and manner, 
specified by the Administrator)— 
‘‘(i) a plan for the State to use its al-
lotment to carry out 3 or more of the activi-
ties described in paragraph (6); and 
‘‘(ii) annual reports on the use of allot-
ments, including such additional informa-
tion as the Administrator determines ap-
propriate. 
‘‘(B) Not more than 10 percent of the 
amount allotted to a State for a fiscal year may 
be used by the State for administrative expenses. 
‘‘(6) USE
OF
FUNDS.—Amounts allotted to a 
State under this subsection shall be used for 3 or more 
of the following health-related activities: 
‘‘(A) Promoting evidence-based, measurable 
interventions to improve prevention and chronic 
disease management. 
‘‘(B) Providing payments to health care 
providers for the provision of health care items 
or services, as specified by the Administrator.
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† HR 1 EAS 
‘‘(C) 
Promoting 
consumer-facing, 
tech-
nology-driven solutions for the prevention and 
management of chronic diseases. 
‘‘(D) Providing training and technical as-
sistance for the development and adoption of 
technology-enabled solutions that improve care 
delivery in rural hospitals, including remote 
monitoring, robotics, artificial intelligence, and 
other advanced technologies. 
‘‘(E) Recruiting and retaining clinical 
workforce talent to rural areas, with commit-
ments to serve rural communities for a min-
imum of 5 years. 
‘‘(F) Providing technical assistance, soft-
ware, and hardware for significant information 
technology advances designed to improve effi-
ciency, enhance cybersecurity capability develop-
ment, and improve patient health outcomes. 
‘‘(G) Assisting rural communities to right 
size their health care delivery systems by identi-
fying needed preventative, ambulatory, pre-hos-
pital, emergency, acute inpatient care, out-
patient care, and post-acute care service lines. 
‘‘(H) Supporting access to opioid use dis-
order treatment services (as defined in section
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† HR 1 EAS 
1861(jjj)(1)), other substance use disorder treat-
ment services, and mental health services. 
‘‘(I) Developing projects that support inno-
vative models of care that include value-based 
care arrangements and alternative payment 
models, as appropriate. 
‘‘(J) Additional uses designed to promote 
sustainable access to high quality rural health 
care services, as determined by the Adminis-
trator. 
‘‘(7) EXEMPTIONS.—Paragraphs (2), (3), (5), 
(6), (8), (10), (11), and (12) of subsection (c) do not 
apply to payments under this subsection. 
‘‘(8) REVIEW.—There shall be no administrative 
or judicial review under section 1116 or otherwise of 
amounts allotted or redistributed to States under this 
subsection, payments to States withheld or reduced 
under this subsection, or previous payments recovered 
from States under this subsection. 
‘‘(9) HEALTH
CARE
PROVIDER
DEFINED.—For 
purposes of this subsection, the term ‘health care pro-
vider’ means a provider of services or supplier who is 
enrolled under this title, title XVIII, or title XIX.’’. 
(b) CONFORMING AMENDMENTS.—Title XXI of the So-
cial Security Act (42 U.S.C. 1397aa) is amended—
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† HR 1 EAS 
(1) in section 2101— 
(A) in subsection (a), in the matter pre-
ceding paragraph (1), by striking ‘‘The purpose’’ 
and inserting ‘‘Except with respect to the rural 
health transformation program established in 
section 2105(h), the purpose’’; and 
(B) in subsection (b), in the matter pre-
ceding paragraph (1), by inserting ‘‘subsection 
(a) or (g) of’’ before ‘‘section 2105’’; 
(2) in section 2105(c)(1), by striking ‘‘and may 
not include’’ and inserting ‘‘or to carry out the rural 
health transformation program established in sub-
section (h) and, except in the case of amounts made 
available under subsection (h), may not include’’; and 
(3) in section 2106(a)(1), by inserting ‘‘sub-
section (a) or (g) of’’ before ‘‘section 2105’’. 
(c) IMPLEMENTATION.—The Administrator of the Cen-
ters for Medicare & Medicaid Services shall implement this 
section, including the amendments made by this section, by 
program instruction or other forms of program guidance. 
(d) IMPLEMENTATION FUNDING.—For the purposes of 
carrying out the provisions of, and the amendments made 
by, this section, there are appropriated, out of any monies 
in the Treasury not otherwise appropriated, to the Admin-
istrator of the Centers for Medicare & Medicaid Services,
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† HR 1 EAS 
$200,000,000 for fiscal year 2025, to remain available until 
expended. 
Subtitle C—Increase in Debt Limit 
SEC. 72001. MODIFICATION OF LIMITATION ON THE PUBLIC 
DEBT. 
The limitation under section 3101(b) of title 31, 
United States Code, as most recently increased by section 
401(b) of Public Law 118–5 (31 U.S.C. 3101 note), is in-
creased by $5,000,000,000,000. 
Subtitle D—Unemployment 
SEC. 73001. ENDING UNEMPLOYMENT PAYMENTS TO JOB-
LESS MILLIONAIRES. 
(a) PROHIBITION ON USE OF FEDERAL FUNDS.— 
(1) IN
GENERAL.—No Federal funds may be 
used— 
(A) to make payments of unemployment 
compensation benefits under an unemployment 
compensation program of the United States in a 
year to an individual whose wages during the 
individual’s base period are equal to or exceed 
$1,000,000; or 
(B) for any administrative costs associated 
with making payments described in subpara-
graph (A). 
(2) COMPLIANCE.—
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† HR 1 EAS 
(A) SELF-CERTIFICATION.—Any applica-
tion for unemployment compensation under an 
unemployment compensation program of the 
United States shall include a form or procedure 
for an individual applicant to certify that such 
individual’s wages during the individual’s base 
period do not equal or exceed $1,000,000. 
(B) VERIFICATION.—Each State agency 
that is responsible for administering any unem-
ployment compensation program of the United 
States shall utilize available systems to verify 
wage eligibility by assessing claimant income to 
the degree possible. 
(3) RECOVERY OF OVERPAYMENTS.—Each State 
agency that is responsible for administering any un-
employment compensation program of the United 
States shall require individuals who have received 
amounts of unemployment compensation under such 
a program to which they were not entitled to repay 
such amounts. 
(4) EFFECTIVE
DATE.—The prohibition under 
paragraph (1) shall apply to weeks of unemployment 
beginning on or after the date of the enactment of this 
Act.
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† HR 1 EAS 
(b) UNEMPLOYMENT COMPENSATION PROGRAM OF THE 
UNITED STATES DEFINED.—In this section, the term ‘‘un-
employment compensation program of the United States’’ 
means— 
(1) unemployment compensation for Federal ci-
vilian employees under subchapter I of chapter 85 of 
title 5, United States Code; 
(2) 
unemployment 
compensation 
for 
ex- 
servicemembers under subchapter II of chapter 85 of 
title 5, United States Code; 
(3) extended benefits under the Federal-State Ex-
tended Unemployment Compensation Act of 1970 (26 
U.S.C. 3304 note); 
(4) any Federal temporary extension of unem-
ployment compensation; 
(5) any Federal program that increases the week-
ly amount of unemployment compensation payable to 
individuals; and 
(6) any other Federal program providing for the 
payment of unemployment compensation, as deter-
mined by the Secretary of Labor.
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† HR 1 EAS 
TITLE 
VIII—COMMITTEE 
ON 
HEALTH, EDUCATION, LABOR, 
AND PENSIONS 
Subtitle A—Exemption of Certain 
Assets 
SEC. 80001. EXEMPTION OF CERTAIN ASSETS. 
(a) 
EXEMPTION
OF
CERTAIN
ASSETS.—Section 
480(f)(2) of the Higher Education Act of 1965 (20 U.S.C. 
1087vv(f)(2)) is amended— 
(1) by striking ‘‘net value of the’’ and inserting 
the following: ‘‘net value of— 
‘‘(A) the’’; 
(2) by striking the period at the end and insert-
ing a semicolon; and 
(3) by adding at the end the following: 
‘‘(B) a family farm on which the family re-
sides; 
‘‘(C) a small business with not more than 
100 full-time or full-time equivalent employees 
(or any part of such a small business) that is 
owned and controlled by the family; or 
‘‘(D) a commercial fishing business and re-
lated expenses, including fishing vessels and per-
mits owned and controlled by the family.’’.
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† HR 1 EAS 
(b) EFFECTIVE DATE AND APPLICATION.—The amend-
ments made by subsection (a) shall take effect on July 1, 
2026, and shall apply with respect to award year 2026– 
2027 and each subsequent award year, as determined under 
the Higher Education Act of 1965 (20 U.S.C. 1001 et seq.). 
Subtitle B—Loan Limits 
SEC. 81001. ESTABLISHMENT OF LOAN LIMITS FOR GRAD-
UATE AND PROFESSIONAL STUDENTS AND 
PARENT 
BORROWERS; 
TERMINATION 
OF 
GRADUATE AND PROFESSIONAL PLUS LOANS. 
Section 455(a) of the Higher Education Act of 1965 
(20 U.S.C. 1087e(a)) is amended— 
(1) in paragraph (3)— 
(A) in the paragraph heading, by inserting 
‘‘AND
FEDERAL
DIRECT
PLUS
LOANS’’ after 
‘‘LOANS’’; 
(B) by striking subparagraph (A) and in-
serting the following: 
‘‘(A) TERMINATION OF AUTHORITY TO MAKE 
INTEREST SUBSIDIZED LOANS TO GRADUATE AND 
PROFESSIONAL STUDENTS.—Subject to subpara-
graph (B), and notwithstanding any provision of 
this part or part B— 
‘‘(i) for any period of instruction be-
ginning on or after July 1, 2012, a grad-
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† HR 1 EAS 
uate or professional student shall not be eli-
gible to receive a Federal Direct Stafford 
loan under this part; and 
‘‘(ii) for any period of instruction be-
ginning on July 1, 2012, and ending on 
June 30, 2026, the maximum annual 
amount of Federal Direct Unsubsidized 
Stafford loans such a student may borrow 
in any academic year (as defined in section 
481(a)(2)) or its equivalent shall be the 
maximum annual amount for such student 
determined under section 428H, plus an 
amount equal to the amount of Federal Di-
rect Stafford loans the student would have 
received in the absence of this subpara-
graph.’’; and 
(C) by adding at the end the following: 
‘‘(C) TERMINATION OF AUTHORITY TO MAKE 
FEDERAL
DIRECT
PLUS
LOANS
TO
GRADUATE 
AND
PROFESSIONAL
STUDENTS.—Subject 
to 
paragraph (8) and notwithstanding any provi-
sion of this part or part B, for any period of in-
struction beginning on or after July 1, 2026, a 
graduate or professional student shall not be eli-
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† HR 1 EAS 
gible to receive a Federal Direct PLUS Loan 
under this part.’’; and 
(2) by adding at the end the following: 
‘‘(4) GRADUATE
AND
PROFESSIONAL
ANNUAL 
AND AGGREGATE LIMITS FOR FEDERAL DIRECT UN-
SUBSIDIZED
STAFFORD
LOANS
BEGINNING
JULY
1, 
2026.— 
‘‘(A) ANNUAL
LIMITS
BEGINNING
JULY
1, 
2026.—Subject to paragraphs (7)(A) and (8), be-
ginning on July 1, 2026, the maximum annual 
amount of Federal Direct Unsubsidized Stafford 
loans— 
‘‘(i) a graduate student, who is not a 
professional student, may borrow in any 
academic year or its equivalent shall be 
$20,500; and 
‘‘(ii) a professional student may bor-
row in any academic year or its equivalent 
shall be $50,000. 
‘‘(B) AGGREGATE LIMITS.—Subject to para-
graphs (6), (7)(A), and (8), beginning on July 1, 
2026, the maximum aggregate amount of Federal 
Direct Unsubsidized Stafford loans, in addition 
to the amount borrowed for undergraduate edu-
cation, that—
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† HR 1 EAS 
‘‘(i) a graduate student— 
‘‘(I) who is not (and has not been) 
a professional student, may borrow for 
programs of study described in sub-
paragraph (C)(i) shall be $100,000; or 
‘‘(II) who is (or has been) a pro-
fessional student, may borrow for pro-
grams of study described in subpara-
graph (C)(i) shall be an amount equal 
to— 
‘‘(aa) $200,000; minus 
‘‘(bb) the amount such stu-
dent borrowed for programs of 
study described in subparagraph 
(C)(ii); and 
‘‘(ii) a professional student— 
‘‘(I) who is not (and has not been) 
a graduate student, may borrow for 
programs of study described in sub-
paragraph (C)(ii) shall be $200,000; or 
‘‘(II) who is (or has been) a grad-
uate student, may borrow for programs 
of study described in subparagraph 
(C)(ii) shall be an amount equal to— 
‘‘(aa) $200,000; minus
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† HR 1 EAS 
‘‘(bb) the amount such stu-
dent borrowed for programs of 
study described in subparagraph 
(C)(i). 
‘‘(C) DEFINITIONS.— 
‘‘(i) GRADUATE STUDENT.—The term 
‘graduate student’ means a student enrolled 
in a program of study that awards a grad-
uate credential (other than a professional 
degree) upon completion of the program. 
‘‘(ii) 
PROFESSIONAL
STUDENT.—In 
this paragraph, the term ‘professional stu-
dent’ means a student enrolled in a pro-
gram of study that awards a professional 
degree, as defined under section 668.2 of 
title 34, Code of Federal Regulations (as in 
effect on the date of enactment of this para-
graph), upon completion of the program. 
‘‘(5) PARENT BORROWER ANNUAL AND AGGRE-
GATE LIMITS FOR FEDERAL DIRECT PLUS LOANS BE-
GINNING JULY 1, 2026.— 
‘‘(A) ANNUAL
LIMITS.—Subject to para-
graph (8) and notwithstanding any provision of 
this part or part B, beginning on July 1, 2026, 
for each dependent student, the total maximum
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† HR 1 EAS 
annual amount of Federal Direct PLUS loans 
that may be borrowed on behalf of that depend-
ent student by all parents of that dependent stu-
dent shall be $20,000. 
‘‘(B) AGGREGATE LIMITS.—Subject to para-
graph (8) and notwithstanding any provision of 
this part or part B, beginning on July 1, 2026, 
for each dependent student, the total maximum 
aggregate amount of Federal Direct PLUS loans 
that may be borrowed on behalf of that depend-
ent student by all parents of that dependent stu-
dent shall be $65,000, without regard to any 
amounts repaid, forgiven, canceled, or otherwise 
discharged on any such loan. 
‘‘(6) LIFETIME
MAXIMUM
AGGREGATE
AMOUNT 
FOR ALL STUDENTS.—Subject to paragraph (8) and 
notwithstanding any provision of this part or part B, 
beginning on July 1, 2026, the maximum aggregate 
amount of loans made, insured, or guaranteed under 
this title that a student may borrow (other than a 
Federal Direct PLUS loan, or loan under section 
428B, made to the student as a parent borrower on 
behalf of a dependent student) shall be $257,500, 
without regard to any amounts repaid, forgiven, can-
celed, or otherwise discharged on any such loan.
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† HR 1 EAS 
‘‘(7) ADDITIONAL
RULES
REGARDING
ANNUAL 
LOAN LIMITS.— 
‘‘(A) LESS
THAN
FULL-TIME
ENROLL-
MENT.—Notwithstanding any provision of this 
part or part B, in any case in which a student 
is enrolled in a program of study of an institu-
tion of higher education on less than a full-time 
basis during any academic year, the amount of 
a loan that student may borrow for an academic 
year or its equivalent shall be reduced in direct 
proportion to the degree to which that student is 
not so enrolled on a full-time basis, rounded to 
the nearest whole percentage point, as provided 
in a schedule of reductions published by the Sec-
retary computed for purposes of this subpara-
graph. 
‘‘(B) INSTITUTIONALLY
DETERMINED
LIM-
ITS.—Notwithstanding the annual loan limits 
established under this section and, for under-
graduate students, under this part and part B, 
beginning on July 1, 2026, an institution of 
higher education (at the discretion of a financial 
aid administrator at the institution) may limit 
the total amount of loans made under this part 
for a program of study for an academic year
697 
† HR 1 EAS 
that a student may borrow, and that a parent 
may borrow on behalf of such student, as long as 
any such limit is applied consistently to all stu-
dents enrolled in such program of study. 
‘‘(8) INTERIM
EXCEPTION
FOR
CERTAIN
STU-
DENTS.— 
‘‘(A) APPLICATION
OF
PRIOR
LIMITS.— 
Paragraphs (3)(C), (4), (5), and (6) shall not 
apply, and paragraph (3)(A)(ii) shall apply as 
such paragraph was in effect for periods of in-
struction ending before June 30, 2026, during 
the expected time to credential described in sub-
paragraph (B), with respect to an individual 
who, as of June 30, 2026— 
‘‘(i) is enrolled in a program of study 
at an institution of higher education; and 
‘‘(ii) has received a loan (or on whose 
behalf a loan was made) under this part for 
such program of study. 
‘‘(B) EXPECTED
TIME
TO
CREDENTIAL.— 
For purposes of this paragraph, the expected 
time to credential of an individual shall be equal 
to the lesser of— 
‘‘(i) three academic years; or
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† HR 1 EAS 
‘‘(ii) the period determined by calcu-
lating the difference between— 
‘‘(I) the program length for the 
program of study in which the indi-
vidual is enrolled; and 
‘‘(II) the period of such program 
of study that such individual has com-
pleted as of the date of the determina-
tion under this subparagraph. 
‘‘(C) DEFINITION OF PROGRAM LENGTH.— 
In this paragraph, the term ‘program length’ 
means the minimum amount of time in weeks, 
months, or years that is specified in the catalog, 
marketing materials, or other official publica-
tions of an institution of higher education for a 
full-time student to complete the requirements for 
a specific program of study.’’. 
Subtitle C—Loan Repayment 
SEC. 82001. LOAN REPAYMENT. 
(a) TRANSITION
TO
INCOME-BASED
REPAYMENT 
PLANS.— 
(1) SELECTION.—The Secretary of Education 
shall take such steps as may be necessary to ensure 
that before July 1, 2028, each borrower who has one 
or more loans that are in a repayment status in ac-
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† HR 1 EAS 
cordance with, or an administrative forbearance asso-
ciated with, an income contingent repayment plan 
authorized under section 455(e) of the Higher Edu-
cation Act of 1965 (referred to in this subsection as 
‘‘covered income contingent loans’’) selects one of the 
following income-based repayment plans that is other-
wise applicable, and for which that borrower is other-
wise eligible, for the repayment of the covered income 
contingent loans of the borrower: 
(A) The Repayment Assistance Plan under 
section 455(q) of the Higher Education Act of 
1965. 
(B) The income-based repayment plan 
under section 493C of the Higher Education Act 
of 1965. 
(C) Any other repayment plan as author-
ized under section 455(d)(1) of the Higher Edu-
cation Act of 1965. 
(2) 
COMMENCEMENT
OF
NEW
REPAYMENT 
PLAN.—Beginning on July 1, 2028, a borrower de-
scribed in paragraph (1) shall begin repaying the cov-
ered income contingent loans of the borrower in ac-
cordance with the repayment plan selected under 
paragraph (1), unless the borrower chooses to begin
700 
† HR 1 EAS 
repaying in accordance with the repayment plan se-
lected under paragraph (1) before such date. 
(3) FAILURE TO SELECT.—In the case of a bor-
rower described in paragraph (1) who fails to select 
a repayment plan in accordance with such para-
graph, the Secretary of Education shall— 
(A) enroll the covered income contingent 
loans of such borrower in— 
(i) the Repayment Assistance Plan 
under section 455(q) of the Higher Edu-
cation Act of 1965 with respect to loans 
that are eligible for the Repayment Assist-
ance Plan under such subsection; or 
(ii) the income-based repayment plan 
under section 493C of such Act, with respect 
to loans that are not eligible for the Repay-
ment Assistance Plan; and 
(B) require the borrower to begin repaying 
covered income contingent loans according to the 
plans under subparagraph (A) on July 1, 2028. 
(b) REPAYMENT PLANS.—Section 455(d) of the Higher 
Education Act of 1965 (20 U.S.C. 1087e(d)) is amended— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘before July 1, 2026, who has
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† HR 1 EAS 
not received a loan made under this part on or 
after July 1, 2026,’’ after ‘‘made under this 
part’’; 
(B) in subparagraph (D)— 
(i) by inserting ‘‘before June 30, 
2028,’’ before ‘‘an income contingent repay-
ment plan’’; and 
(ii) by striking ‘‘and’’ after the semi-
colon; 
(C) in subparagraph (E)— 
(i) by striking ‘‘that enables borrowers 
who have a partial financial hardship to 
make a lower monthly payment’’; 
(ii) by striking ‘‘a Federal Direct Con-
solidation Loan, if the proceeds of such loan 
were used to discharge the liability on such 
Federal Direct PLUS Loan or a loan under 
section 428B made on behalf of a dependent 
student’’ and inserting ‘‘an excepted Con-
solidation Loan (as defined in section 
493C(a)(2))’’; and 
(iii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(D) by adding at the end the following:
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† HR 1 EAS 
‘‘(F) beginning on July 1, 2026, the in-
come-based Repayment Assistance Plan under 
subsection (q), provided that— 
‘‘(i) such Plan shall not be available 
for the repayment of excepted loans (as de-
fined in paragraph (7)(E)); and 
‘‘(ii) the borrower is required to pay 
each outstanding loan of the borrower made 
under this part under such Repayment As-
sistance Plan, except that a borrower of an 
excepted loan (as defined in paragraph 
(7)(E)) may repay the excepted loan sepa-
rately from other loans under this part ob-
tained by the borrower.’’; 
(2) in paragraph (5), by amending subpara-
graph (B) to read as follows: 
‘‘(B) repay the loan pursuant to an income- 
based repayment plan under subsection (q) or 
section 493C, as applicable.’’; and 
(3) by adding at the end the following: 
‘‘(6) TERMINATION AND LIMITATION OF REPAY-
MENT AUTHORITY.— 
‘‘(A) SUNSET OF REPAYMENT PLANS AVAIL-
ABLE
BEFORE
JULY
1, 2026.—Paragraphs (1)
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† HR 1 EAS 
through (4) of this subsection shall only apply to 
loans made under this part before July 1, 2026. 
‘‘(B) PROHIBITIONS.—The Secretary may 
not, for any loan made under this part on or 
after July 1, 2026— 
‘‘(i) authorize a borrower of such a 
loan to repay such loan pursuant to a re-
payment plan that is not described in para-
graph (7)(A); or 
‘‘(ii) carry out or modify a repayment 
plan that is not described in such para-
graph. 
‘‘(7) REPAYMENT PLANS FOR LOANS MADE ON OR 
AFTER JULY 1, 2026.— 
‘‘(A) DESIGN AND SELECTION.—Beginning 
on July 1, 2026, the Secretary shall offer a bor-
rower of a loan made under this part on or after 
such date (including such a borrower who also 
has a loan made under this part before such 
date) two plans for repayment of the borrower’s 
loans under this part, including principal and 
interest on such loans. The borrower shall be en-
titled to accelerate, without penalty, repayment 
on such loans. The borrower may choose— 
‘‘(i) a standard repayment plan—
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† HR 1 EAS 
‘‘(I) with a fixed monthly repay-
ment amount paid over a fixed period 
of time equal to the applicable period 
determined under subclause (II); and 
‘‘(II) with the applicable period of 
time for repayment determined based 
on the total outstanding principal of 
all loans of the borrower made under 
this part before, on, or after July 1, 
2026, at the time the borrower is enter-
ing repayment under such plan, as fol-
lows— 
‘‘(aa) for a borrower with 
total outstanding principal of less 
than $25,000, a period of 10 
years; 
‘‘(bb) for a borrower with 
total outstanding principal of not 
less than $25,000 and less than 
$50,000, a period of 15 years; 
‘‘(cc) for a borrower with 
total outstanding principal of not 
less than $50,000 and less than 
$100,000, a period of 20 years; 
and
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† HR 1 EAS 
‘‘(dd) for a borrower with 
total outstanding principal of 
$100,000 or more, a period of 25 
years; or 
‘‘(ii) the income-based Repayment As-
sistance Plan under subsection (q). 
‘‘(B) SELECTION BY SECRETARY.—If a bor-
rower of a loan made under this part on or after 
July 1, 2026, does not select a repayment plan 
described in subparagraph (A), the Secretary 
shall provide the borrower with the standard re-
payment plan described in subparagraph (A)(i). 
‘‘(C) SELECTION
APPLIES
TO
ALL
OUT-
STANDING
LOANS.—A borrower is required to 
pay each outstanding loan of the borrower made 
under this part under the same selected repay-
ment plan, except that a borrower who selects the 
Repayment Assistance Plan and also has an ex-
cepted loan that is not eligible for repayment 
under such Repayment Assistance Plan shall 
repay the excepted loan separately from other 
loans under this part obtained by the borrower. 
‘‘(D) CHANGES
OF
REPAYMENT
PLAN.—A 
borrower may change the borrower’s selection 
of—
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† HR 1 EAS 
‘‘(i) the standard repayment plan 
under subparagraph (A)(i), or the Sec-
retary’s selection of such plan for the bor-
rower under subparagraph (B), as the case 
may be, to the Repayment Assistance Plan 
under subparagraph (A)(ii) at any time; 
and 
‘‘(ii) the Repayment Assistance Plan 
under subparagraph (A)(ii) to the standard 
repayment plan under subparagraph (A)(i) 
at any time. 
‘‘(E) REPAYMENT
FOR
BORROWERS
WITH 
EXCEPTED LOANS MADE ON OR AFTER JULY 1, 
2026.— 
‘‘(i) STANDARD REPAYMENT PLAN RE-
QUIRED.—Notwithstanding 
subparagraphs 
(A) through (D), beginning on July 1, 2026, 
the Secretary shall require a borrower who 
has received an excepted loan made on or 
after such date (including such a borrower 
who also has an excepted loan made before 
such date) to repay each excepted loan, in-
cluding principal and interest on those ex-
cepted loans, under the standard repayment 
plan under subparagraph (A)(i). The bor-
707 
† HR 1 EAS 
rower shall be entitled to accelerate, without 
penalty, repayment on such loans. 
‘‘(ii) EXCEPTED LOAN DEFINED.—For 
the purposes of this paragraph, the term ‘ex-
cepted loan’ means a loan with an out-
standing balance that is— 
‘‘(I) a Federal Direct PLUS Loan 
that is made on behalf of a dependent 
student; or 
‘‘(II) a Federal Direct Consolida-
tion Loan, if the proceeds of such loan 
were used to discharge the liability 
on— 
‘‘(aa) an excepted PLUS 
loan, 
as 
defined 
in 
section 
493C(a)(1); or 
‘‘(bb) an excepted consolida-
tion loan (as such term is defined 
in section 493C(a)(2)(A), notwith-
standing subparagraph (B) of 
such section).’’. 
(c) ELIMINATION OF AUTHORITY TO PROVIDE INCOME 
CONTINGENT REPAYMENT PLANS.—
708 
† HR 1 EAS 
(1) REPEAL.—Subsection (e) of section 455 of 
the Higher Education Act of 1965 (20 U.S.C. 
1087e(e)) is repealed. 
(2) FURTHER AMENDMENTS TO ELIMINATE IN-
COME CONTINGENT REPAYMENT.— 
(A) Section 428 of the Higher Education 
Act of 1965 (20 U.S.C. 1078) is amended— 
(i) in subsection (b)(1)(D), by striking 
‘‘be subject to income contingent repayment 
in accordance with subsection (m)’’ and in-
serting ‘‘be subject to income-based repay-
ment in accordance with subsection (m)’’; 
and 
(ii) in subsection (m)— 
(I) in the subsection heading, by 
striking ‘‘INCOME CONTINGENT AND’’; 
(II) by amending paragraph (1) 
to read as follows: 
‘‘(1) AUTHORITY OF SECRETARY TO REQUIRE.— 
The Secretary may require borrowers who have de-
faulted on loans made under this part that are as-
signed to the Secretary under subsection (c)(8) to 
repay those loans pursuant to an income-based repay-
ment plan under section 493C.’’; and
709 
† HR 1 EAS 
(III) in the heading of paragraph 
(2), by striking ‘‘INCOME CONTINGENT 
OR’’. 
(B) Section 428C of the Higher Education 
Act of 1965 (20 U.S.C. 1078–3) is amended— 
(i) in subsection (a)(3)(B)(i)(V)(aa), 
by striking ‘‘for the purposes of obtaining 
income contingent repayment or income- 
based repayment’’ and inserting ‘‘for the 
purposes of qualifying for an income-based 
repayment plan under section 455(q) or sec-
tion 493C, as applicable’’; 
(ii) in subsection (b)(5), by striking 
‘‘be repaid either pursuant to income con-
tingent repayment under part D of this 
title, pursuant to income-based repayment 
under section 493C, or pursuant to any 
other repayment provision under this sec-
tion’’ and inserting ‘‘be repaid pursuant to 
an income-based repayment plan under sec-
tion 493C or any other repayment provi-
sion under this section’’; and 
(iii) in subsection (c)— 
(I) in paragraph (2)(A), by strik-
ing ‘‘or by the terms of repayment pur-
710 
† HR 1 EAS 
suant to income contingent repayment 
offered by the Secretary under sub-
section (b)(5)’’ and inserting ‘‘or by 
the terms of repayment pursuant to an 
income-based repayment plan under 
section 493C’’; and 
(II) in paragraph (3)(B), by 
striking ‘‘except as required by the 
terms of repayment pursuant to in-
come contingent repayment offered by 
the Secretary under subsection (b)(5)’’ 
and inserting ‘‘except as required by 
the terms of repayment pursuant to an 
income-based repayment plan under 
section 493C’’. 
(C) Section 485(d)(1) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1092(d)(1)) is 
amended by striking ‘‘income-contingent and’’. 
(D) Section 494(a)(2) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1098h(a)(2)) is 
amended— 
(i) in the paragraph heading, by strik-
ing ‘‘INCOME-CONTINGENT
AND
INCOME- 
BASED’’ and inserting ‘‘INCOME-BASED’’; 
and
711 
† HR 1 EAS 
(ii) in subparagraph (A)— 
(I) in the matter preceding clause 
(i), by striking ‘‘income-contingent or’’; 
and 
(II) in clause (ii)(I), by striking 
‘‘section 455(e)(8) or the equivalent 
procedures established under section 
493C(c)(2)(B), as applicable’’ and in-
serting ‘‘section 493C(c)(2)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on July 1, 2028. 
(d) REPAYMENT ASSISTANCE PLAN.—Section 455 of 
the Higher Education Act of 1965 (20 U.S.C. 1087e) is 
amended by adding at the end the following new subsection: 
‘‘(q) REPAYMENT ASSISTANCE PLAN.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this Act, beginning on July 1, 2026, the 
Secretary shall carry out an income-based repayment 
plan (to be known as the ‘Repayment Assistance 
Plan’), that shall have the following terms and condi-
tions: 
‘‘(A) The total monthly repayment amount 
owed by a borrower for all of the loans of the 
borrower that are repaid pursuant to the Repay-
ment Assistance Plan shall be equal to the appli-
712 
† HR 1 EAS 
cable monthly payment of a borrower calculated 
under paragraph (4)(B), except that the bor-
rower may not be precluded from repaying an 
amount that exceeds such amount for any month. 
‘‘(B) The Secretary shall apply the bor-
rower’s applicable monthly payment under this 
paragraph first toward interest due on each such 
loan, next toward any fees due on each loan, and 
then toward the principal of each loan. 
‘‘(C) Any principal due and not paid under 
subparagraph (B) or paragraph (2)(B) shall be 
deferred. 
‘‘(D) A borrower who is not in a period of 
deferment or forbearance shall make an applica-
ble monthly payment for each month until the 
earlier of— 
‘‘(i) the date on which the outstanding 
balance of principal and interest due on all 
of the loans of the borrower that are repaid 
pursuant to the Repayment Assistance Plan 
is $0; or 
‘‘(ii) the date on which the borrower 
has made 360 qualifying monthly pay-
ments.
713 
† HR 1 EAS 
‘‘(E) The Secretary shall cancel any out-
standing balance of principal and interest due 
on a loan made under this part to a borrower— 
‘‘(i) who, for any period of time, par-
ticipated in the Repayment Assistance Plan 
under this subsection; 
‘‘(ii) whose most recent payment for 
such loan prior to the loan cancellation 
under this subparagraph was made under 
such Repayment Assistance Plan; and 
‘‘(iii) who has made 360 qualifying 
monthly payments on such loan. 
‘‘(F) For the purposes of this subsection, the 
term ‘qualifying monthly payment’ means any 
of the following: 
‘‘(i) An on-time applicable monthly 
payment under this subsection. 
‘‘(ii) An on-time monthly payment 
under the standard repayment plan under 
subsection (d)(7)(A)(i) of not less than the 
monthly payment required under such plan. 
‘‘(iii) A monthly payment under any 
repayment plan (excluding the Repayment 
Assistance Plan under this subsection) of 
not less than the monthly payment that
714 
† HR 1 EAS 
would be required under a standard repay-
ment plan under section 455(d)(1)(A) with 
a repayment period of 10 years. 
‘‘(iv) A monthly payment under sec-
tion 493C of not less than the monthly pay-
ment required under such section, including 
a monthly payment equal to the minimum 
payment amount permitted under such sec-
tion. 
‘‘(v) A monthly payment made before 
July 1, 2028, under an income contingent 
repayment plan carried out under section 
455(d)(1)(D) (or under an alternative re-
payment plan in lieu of repayment under 
such an income contingent repayment plan, 
if placed in such an alternative repayment 
plan by the Secretary) of not less than the 
monthly payment required under such a 
plan, including a monthly payment equal 
to the minimum payment amount per-
mitted under such a plan. 
‘‘(vi) A month when the borrower did 
not make a payment because the borrower 
was in deferment under subsection (f)(2)(B)
715 
† HR 1 EAS 
or due to an economic hardship described in 
subsection (f)(2)(D). 
‘‘(vii) A month that ended before the 
date of enactment of this subsection when 
the borrower did not make a payment be-
cause the borrower was in a period of 
deferment or forbearance described in sec-
tion 685.209(k)(4)(iv) of title 34, Code of 
Federal Regulations (as in effect on the date 
of enactment of this subsection). 
‘‘(G) The procedures established by the Sec-
retary under section 493C(c) shall apply for an-
nually determining the borrower’s eligibility for 
the 
Repayment 
Assistance 
Plan, 
including 
verification of a borrower’s annual income and 
the annual amount due on the total amount of 
loans eligible to be repaid under this subsection, 
and such other procedures as are necessary to ef-
fectively implement income-based repayment 
under this subsection. With respect to carrying 
out section 494(a)(2) for the Repayment Assist-
ance Plan, an individual may elect to opt out of 
the 
disclosures 
required 
under 
section 
494(a)(2)(A)(ii) in accordance with the proce-
dures established under section 493C(c)(2).
716 
† HR 1 EAS 
‘‘(2) BALANCE
ASSISTANCE
FOR
DISTRESSED 
BORROWERS.— 
‘‘(A) INTEREST SUBSIDY.—With respect to 
a borrower of a loan made under this part, for 
each month for which such a borrower makes an 
on-time applicable monthly payment required 
under paragraph (1)(A) and such monthly pay-
ment is insufficient to pay the total amount of 
interest that accrues for the month on all loans 
of the borrower repaid pursuant to the Repay-
ment Assistance Plan under this subsection, the 
amount of interest accrued and not paid for the 
month shall not be charged to the borrower. 
‘‘(B) MATCHING
PRINCIPAL
PAYMENT.— 
With respect to a borrower of a loan made under 
this part and not in a period of deferment or 
forbearance, for each month for which a borrower 
makes an on-time applicable monthly payment 
required under paragraph (1)(A) and such 
monthly payment reduces the total outstanding 
principal balance of all loans of the borrower re-
paid pursuant to the Repayment Assistance Plan 
under this subsection by less than $50, the Sec-
retary shall reduce such total outstanding prin-
717 
† HR 1 EAS 
cipal balance of the borrower by an amount that 
is equal to— 
‘‘(i) the amount that is the lesser of— 
‘‘(I) $50; or 
‘‘(II) the total amount paid by the 
borrower for such month pursuant to 
paragraph (1)(A); minus 
‘‘(ii) the total amount paid by the bor-
rower for such month pursuant to para-
graph (1)(A) that is applied to such total 
outstanding principal balance. 
‘‘(3) ADDITIONAL DOCUMENTS.—A borrower who 
chooses, or is required, to repay a loan under this 
subsection, and for whom adjusted gross income is un-
available or does not reasonably reflect the borrower’s 
current income, shall provide to the Secretary other 
documentation of income satisfactory to the Secretary, 
which documentation the Secretary may use to deter-
mine repayment under this subsection. 
‘‘(4) DEFINITIONS.—In this subsection: 
‘‘(A) ADJUSTED GROSS INCOME.—The term 
‘adjusted gross income’, when used with respect 
to a borrower, means the adjusted gross income 
(as such term is defined in section 62 of the In-
ternal Revenue Code of 1986) of the borrower
718 
† HR 1 EAS 
(and the borrower’s spouse, as applicable) for the 
most recent taxable year, except that, in the case 
of a married borrower who files a separate Fed-
eral income tax return, the term does not include 
the adjusted gross income of the borrower’s 
spouse. 
‘‘(B) APPLICABLE MONTHLY PAYMENT.— 
‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), (iii), or (vi), the term ‘appli-
cable monthly payment’ means, when used 
with respect to a borrower, the amount 
equal to— 
‘‘(I) the applicable base payment 
of the borrower, divided by 12; minus 
‘‘(II) $50 for each dependent of 
the borrower (which, in the case of a 
married borrower filing a separate 
Federal income tax return, shall in-
clude only each dependent that the bor-
rower claims on that return). 
‘‘(ii) MINIMUM AMOUNT.—In the case 
of a borrower with an applicable monthly 
payment amount calculated under clause (i) 
that is less than $10, the applicable month-
ly payment of the borrower shall be $10.
719 
† HR 1 EAS 
‘‘(iii) FINAL PAYMENT.—In the case of 
a borrower whose total outstanding balance 
of principal and interest on all of the loans 
of the borrower that are repaid pursuant to 
the Repayment Assistance Plan is less than 
the applicable monthly payment calculated 
pursuant to clause (i) or (ii), as applicable, 
then the applicable monthly payment of the 
borrower shall be the total outstanding bal-
ance of principal and interest on all such 
loans. 
‘‘(iv) BASE PAYMENT.—The amount of 
the applicable base payment for a borrower 
with an adjusted gross income of— 
‘‘(I) not more than $10,000, is 
$120; 
‘‘(II) more than $10,000 and not 
more than $20,000, is 1 percent of such 
adjusted gross income; 
‘‘(III) more than $20,000 and not 
more than $30,000, is 2 percent of such 
adjusted gross income; 
‘‘(IV) more than $30,000 and not 
more than $40,000, is 3 percent of such 
adjusted gross income;
720 
† HR 1 EAS 
‘‘(V) more than $40,000 and not 
more than $50,000, is 4 percent of such 
adjusted gross income; 
‘‘(VI) more than $50,000 and not 
more than $60,000, is 5 percent of such 
adjusted gross income; 
‘‘(VII) more than $60,000 and not 
more than $70,000, is 6 percent of such 
adjusted gross income; 
‘‘(VIII) more than $70,000 and 
not more than $80,000, is 7 percent of 
such adjusted gross income; 
‘‘(IX) more than $80,000 and not 
more than $90,000, is 8 percent of such 
adjusted gross income; 
‘‘(X) more than $90,000 and not 
more than $100,000, is 9 percent of 
such adjusted gross income; and 
‘‘(XI) more than $100,000, is 10 
percent of such adjusted gross income. 
‘‘(v) DEPENDENT.—For the purposes of 
this paragraph, the term ‘dependent’ means 
an individual who is a dependent under 
section 152 of the Internal Revenue Code of 
1986.
721 
† HR 1 EAS 
‘‘(vi) SPECIAL RULE.—In the case of a 
borrower who is required by the Secretary 
to provide information to the Secretary to 
determine the applicable monthly payment 
of the borrower under this subparagraph, 
and who does not comply with such require-
ment, the applicable monthly payment of 
the borrower shall be— 
‘‘(I) the sum of the monthly pay-
ment amounts the borrower would have 
paid for each of the borrower’s loans 
made under this part under a stand-
ard repayment plan with a fixed 
monthly repayment amount, paid over 
a period of 10 years, based on the out-
standing principal due on such loan 
when such loan entered repayment; 
and 
‘‘(II) determined pursuant to this 
clause until the date on which the bor-
rower provides such information to the 
Secretary.’’. 
(e) FEDERAL CONSOLIDATION LOANS.—Section 455(g) 
of the Higher Education Act of 1965 (20 U.S.C. 1087e(g))
722 
† HR 1 EAS 
is amended by adding at the end the following new para-
graph: 
‘‘(3) CONSOLIDATION LOANS MADE ON OR AFTER 
JULY 1, 2026.—A Federal Direct Consolidation Loan 
offered to a borrower under this part on or after July 
1, 2026, may only be repaid pursuant to a repayment 
plan described in clause (i) or (ii) of subsection 
(d)(7)(A) of this section, as applicable, and the repay-
ment schedule of such a Consolidation Loan shall be 
determined in accordance with such repayment 
plan.’’. 
(f) INCOME-BASED REPAYMENT.— 
(1) AMENDMENTS.— 
(A) EXCEPTED
CONSOLIDATION
LOAN
DE-
FINED.—Section 493C(a)(2) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1098e(a)(2)) is 
amended to read as follows: 
‘‘(2) EXCEPTED CONSOLIDATION LOAN.— 
‘‘(A) IN GENERAL.—The term ‘excepted con-
solidation loan’ means— 
‘‘(i) a consolidation loan under section 
428C, or a Federal Direct Consolidation 
Loan, if the proceeds of such loan were used 
to discharge the liability on an excepted 
PLUS loan; or
723 
† HR 1 EAS 
‘‘(ii) a consolidation loan under sec-
tion 428C, or a Federal Direct Consolida-
tion Loan, if the proceeds of such loan were 
used to discharge the liability on a consoli-
dation loan under section 428C, or a Fed-
eral Direct Consolidation Loan described in 
clause (i). 
‘‘(B) EXCLUSION.—The term ‘excepted con-
solidation loan’ does not include a Federal Di-
rect Consolidation Loan described in subpara-
graph (A) that, on any date during the period 
beginning on the date of enactment of this sub-
paragraph and ending on June 30, 2028, was 
being repaid— 
‘‘(i) pursuant to the Income Contin-
gent Repayment (ICR) plan in accordance 
with section 685.209(b) of title 34, Code of 
Federal Regulations (as in effect on June 
30, 2023); or 
‘‘(ii) pursuant to another income driv-
en repayment plan.’’. 
(B) TERMINATION OF PARTIAL FINANCIAL 
HARDSHIP ELIGIBILITY.—Section 493C(a)(3) of 
the Higher Education Act of 1965 (20 U.S.C. 
1098e(a)(3)) is amended to read as follows:
724 
† HR 1 EAS 
‘‘(3) APPLICABLE AMOUNT.—The term ‘applica-
ble amount’ means 15 percent of the result obtained 
by calculating, on at least an annual basis, the 
amount by which— 
‘‘(A) the borrower’s, and the borrower’s 
spouse’s (if applicable), adjusted gross income; 
exceeds 
‘‘(B) 150 percent of the poverty line appli-
cable to the borrower’s family size as determined 
under section 673(2) of the Community Services 
Block Grant Act (42 U.S.C. 9902(2)).’’. 
(C) TERMS
OF
INCOME-BASED
REPAY-
MENT.—Section 493C(b) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1098e(b)) is 
amended— 
(i) by amending paragraph (1) to read 
as follows: 
‘‘(1) a borrower of any loan made, insured, or 
guaranteed under part B or D (other than an ex-
cepted PLUS loan or excepted consolidation loan), 
may elect to have the borrower’s aggregate monthly 
payment for all such loans not exceed the applicable 
amount divided by 12;’’; 
(ii) by striking paragraph (6) and in-
serting the following:
725 
† HR 1 EAS 
‘‘(6) if the monthly payment amount calculated 
under this section for all loans made to the borrower 
under part B or D (other than an excepted PLUS 
loan or excepted consolidation loan) exceeds the 
monthly 
amount 
calculated 
under 
section 
428(b)(9)(A)(i) or 455(d)(1)(A), based on a 10-year 
repayment period, when the borrower first made the 
election described in this subsection (referred to in 
this paragraph as the ‘standard monthly repayment 
amount’), or if the borrower no longer wishes to con-
tinue the election under this subsection, then— 
‘‘(A) the maximum monthly payment re-
quired to be paid for all loans made to the bor-
rower under part B or D (other than an excepted 
PLUS loan or excepted consolidation loan) shall 
be the standard monthly repayment amount; and 
‘‘(B) the amount of time the borrower is 
permitted to repay such loans may exceed 10 
years;’’; 
(iii) in paragraph (7)(B)(iv), by in-
serting ‘‘(as such section was in effect on the 
day before the date of the repeal of section 
455(e)’’ after ‘‘section 455(d)(1)(D)’’; and 
(iv) in paragraph (8), by inserting ‘‘or 
the Repayment Assistance Program under
726 
† HR 1 EAS 
section 455(q)’’ after ‘‘standard repayment 
plan’’. 
(D) ELIGIBILITY
DETERMINATIONS.—Sec-
tion 493C(c) of the Higher Education Act of 
1965 (20 U.S.C. 1098e(c)) is amended to read as 
follows: 
‘‘(c) ELIGIBILITY DETERMINATIONS; AUTOMATIC RE-
CERTIFICATION.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
procedures for annually determining, in accordance 
with paragraph (2), the borrower’s eligibility for in-
come-based repayment, including the verification of a 
borrower’s annual income and the annual amount 
due on the total amount of loans made, insured, or 
guaranteed under part B or D (other than an ex-
cepted PLUS loan or excepted consolidation loan), 
and such other procedures as are necessary to effec-
tively implement income-based repayment under this 
section. The Secretary shall consider, but is not lim-
ited to, the procedures established in accordance with 
section 455(e)(1) (as in effect on the day before the 
date of repeal of subsection (e) of section 455) or in 
connection with income sensitive repayment schedules 
under section 428(b)(9)(A)(iii) or 428C(b)(1)(E). 
‘‘(2) AUTOMATIC RECERTIFICATION.—
727 
† HR 1 EAS 
‘‘(A) IN GENERAL.—The Secretary shall es-
tablish and implement, with respect to any bor-
rower enrolled in an income-based repayment 
program under this section or under section 
455(q), procedures to— 
‘‘(i) use return information disclosed 
under section 6103(l)(13) of the Internal 
Revenue Code of 1986, pursuant to ap-
proval provided under section 494, to deter-
mine the repayment obligation of the bor-
rower without further action by the bor-
rower; 
‘‘(ii) allow the borrower (or the spouse 
of the borrower), at any time, to opt out of 
disclosure under such section 6103(l)(13) 
and instead provide such information as the 
Secretary may require to determine the re-
payment obligation of the borrower (or 
withdraw from the repayment plan under 
this section or under section 455(q), as the 
case may be); and 
‘‘(iii) provide the borrower with an op-
portunity to update the return information 
so disclosed before the determination of the 
repayment obligation of the borrower.
728 
† HR 1 EAS 
‘‘(B) APPLICABILITY.—Subparagraph (A) 
shall apply to each borrower of a loan eligible to 
be repaid under this section or under section 
455(q), who, on or after the date on which the 
Secretary establishes procedures under such sub-
paragraph (A)— 
‘‘(i) selects, or is required to repay 
such loan pursuant to, an income-based re-
payment plan under this section or under 
section 455(q); or 
‘‘(ii) recertifies income or family size 
under such plan.’’. 
(E) SPECIAL TERMS FOR NEW BORROWERS 
ON AND AFTER JULY 1, 2014.—Section 493C(e) of 
the Higher Education Act of 1965 (20 U.S.C. 
1098e(e)) is amended— 
(i) in the subsection heading, by insert-
ing ‘‘AND BEFORE JULY 1, 2026’’ after 
‘‘AFTER JULY 1, 2014’’; and 
(ii) by inserting ‘‘and before July 1, 
2026’’ after ‘‘after July 1, 2014’’. 
(2) EFFECTIVE
DATE
AND
APPLICATION.—The 
amendments made by this subsection shall take effect 
on the date of enactment of this title, and shall apply
729 
† HR 1 EAS 
with respect to any borrower who is in repayment be-
fore, on, or after the date of enactment of this title. 
(g) FFEL ADJUSTMENT.—Section 428(b)(9)(A)(v) of 
the 
Higher 
Education 
Act 
of 
1965 
(20 
U.S.C. 
1078(b)(9)(A)(v)) is amended by striking ‘‘who has a par-
tial financial hardship’’. 
SEC. 82002. DEFERMENT; FORBEARANCE. 
(a) SUNSET OF ECONOMIC HARDSHIP AND UNEMPLOY-
MENT DEFERMENTS.—Section 455(f) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1087e(f)) is amended— 
(1) by striking the subsection heading and in-
serting the following: ‘‘DEFERMENT; FORBEARANCE’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B), by striking ‘‘not 
in’’ and inserting ‘‘subject to paragraph (7), not 
in’’; and 
(B) in subparagraph (D), by striking ‘‘not 
in’’ and inserting ‘‘subject to paragraph (7), not 
in’’; and 
(3) by adding at the end the following: 
‘‘(7) SUNSET OF UNEMPLOYMENT AND ECONOMIC 
HARDSHIP DEFERMENTS.—A borrower who receives a 
loan made under this part on or after July 1, 2027, 
shall not be eligible to defer such loan under subpara-
graph (B) or (D) of paragraph (2).’’.
730 
† HR 1 EAS 
(b) FORBEARANCE
ON LOANS MADE UNDER THIS 
PART ON OR AFTER JULY 1, 2027.—Section 455(f) of the 
Higher Education Act of 1965 (20 U.S.C. 1087e(f)) is 
amended by adding at the end the following: 
‘‘(8) FORBEARANCE
ON
LOANS
MADE
UNDER 
THIS PART ON OR AFTER JULY 1, 2027.—A borrower 
who receives a loan made under this part on or after 
July 1, 2027, may only be eligible for a forbearance 
on such loan pursuant to section 428(c)(3)(B) that 
does not exceed 9 months during any 24-month pe-
riod.’’. 
SEC. 82003. LOAN REHABILITATION. 
(a) UPDATING LOAN REHABILITATION LIMITS.— 
(1) 
FFEL 
AND
DIRECT
LOANS.—Section 
428F(a)(5) of the Higher Education Act of 1965 (20 
U.S.C. 1078–6(a)(5)) is amended by striking ‘‘one 
time’’ and inserting ‘‘two times’’. 
(2) PERKINS
LOANS.—Section 464(h)(1)(D) of 
the Higher Education Act of 1965 (20 U.S.C. 
1087dd(h)(1)(D)) is amended by striking ‘‘once’’ and 
inserting ‘‘twice’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect beginning on July 
1, 2027, and shall apply with respect to any loan 
made, insured, or guaranteed under title IV of the
731 
† HR 1 EAS 
Higher Education Act of 1965 (20 U.S.C. 1070 et 
seq.). 
(b) MINIMUM MONTHLY PAYMENT AMOUNT.—Section 
428F(a)(1)(B) of the Higher Education Act of 1965 (20 
U.S.C. 1078–6(a)(1)(B)) is amended by adding at the end 
the following: ‘‘With respect to a borrower who has 1 or 
more loans made under part D on or after July 1, 2027 
that are described in subparagraph (A), the total monthly 
payment of the borrower for all such loans shall not be less 
than $10.’’. 
SEC. 82004. PUBLIC SERVICE LOAN FORGIVENESS. 
Section 455(m)(1)(A) of the Higher Education Act of 
1965 (20 U.S.C. 1087e(m)(1)(A)) is amended— 
(1) in clause (iii), by striking ‘‘; or’’ and insert-
ing a semicolon; 
(2) in clause (iv), by striking ‘‘; and’’ and in-
serting ‘‘(as in effect on the day before the date of the 
repeal of subsection (e) of this section); or’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(v) on-time payments under the Re-
payment Assistance Plan under subsection 
(q); and’’.
732 
† HR 1 EAS 
SEC. 82005. STUDENT LOAN SERVICING. 
Paragraph (1) of section 458(a) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1087h(a)(1)) is amended to 
read as follows: 
‘‘(1) ADDITIONAL MANDATORY FUNDS FOR SERV-
ICING.—There shall be available to the Secretary (in 
addition to any other amounts appropriated under 
any appropriations Act for administrative costs 
under this part and part B and out of any money 
in 
the 
Treasury 
not 
otherwise 
appropriated) 
$1,000,000,000 to be obligated for administrative costs 
under this part and part B, including the costs of 
servicing the direct student loan programs under this 
part, which shall remain available until expended.’’. 
Subtitle D—Pell Grants 
SEC. 83001. ELIGIBILITY. 
(a) FOREIGN INCOME AND FEDERAL PELL GRANT 
ELIGIBILITY.— 
(1) ADJUSTED GROSS INCOME DEFINED.—Sec-
tion 401(a)(2)(A) of the Higher Education Act of 
1965 (20 U.S.C. 1070a(a)(2)(A)) is amended to read 
as follows: 
‘‘(A) the term ‘adjusted gross income’ 
means—
733 
† HR 1 EAS 
‘‘(i) in the case of a dependent student, 
for the second tax year preceding the aca-
demic year— 
‘‘(I) the adjusted gross income (as 
defined in section 62 of the Internal 
Revenue Code of 1986) of the student’s 
parents; plus 
‘‘(II) for Federal Pell Grant deter-
minations made for academic years be-
ginning on or after July 1, 2026, the 
foreign income (as described in section 
480(b)(5)) of the student’s parents; and 
‘‘(ii) in the case of an independent stu-
dent, for the second tax year preceding the 
academic year— 
‘‘(I) the adjusted gross income (as 
defined in section 62 of the Internal 
Revenue Code of 1986) of the student 
(and the student’s spouse, if applica-
ble); plus 
‘‘(II) for Federal Pell Grant deter-
minations made for academic years be-
ginning on or after July 1, 2026, the 
foreign income (as described in section
734 
† HR 1 EAS 
480(b)(5)) of the student (and the stu-
dent’s spouse, if applicable);’’. 
(2) SUNSET.—Section 401(b)(1)(D) of the High-
er Education Act of 1965 (20 U.S.C. 1070a(b)(1)(D)) 
is amended— 
(A) by striking ‘‘A student’’ and inserting 
‘‘For each academic year beginning before July 
1, 2026, a student’’; and 
(B) by inserting ‘‘, as in effect for such aca-
demic year,’’ after ‘‘section 479A(b)(1)(B)(v)’’. 
(3) CONFORMING AMENDMENTS.— 
(A) IN GENERAL.—Section 479A(b)(1)(B) of 
the Higher Education Act of 1965 (20 U.S.C. 
1087tt(b)(1)(B)) is amended— 
(i) by striking clause (v); and 
(ii) by redesignating clauses (vi) and 
(vii) as clauses (v) and (vi), respectively. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall take effect on 
July 1, 2026. 
(b) FEDERAL PELL GRANT INELIGIBILITY DUE TO A 
HIGH STUDENT AID INDEX.— 
(1) IN GENERAL.—Section 401(b)(1) of the High-
er Education Act of 1965 (20 U.S.C. 1070a(b)(1)) is 
amended by adding at the end the following:
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† HR 1 EAS 
‘‘(F) INELIGIBILITY OF STUDENTS WITH A 
HIGH
STUDENT
AID
INDEX.—Notwithstanding 
subparagraphs (A) through (E), a student shall 
not be eligible for a Federal Pell Grant under 
this subsection for an academic year in which 
the student has a student aid index that equals 
or exceeds twice the amount of the total max-
imum Federal Pell Grant for such academic 
year.’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect on July 1, 2026. 
SEC. 83002. WORKFORCE PELL GRANTS. 
(a) IN GENERAL.—Section 401 of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1070a) is amended by adding 
at the end the following: 
‘‘(k) WORKFORCE PELL GRANT PROGRAM.— 
‘‘(1) IN GENERAL.—For the award year begin-
ning on July 1, 2026, and each subsequent award 
year, the Secretary shall award grants (to be known 
as ‘Workforce Pell Grants’) to eligible students under 
paragraph (2) in accordance with this subsection. 
‘‘(2) ELIGIBLE STUDENTS.—To be eligible to re-
ceive a Workforce Pell Grant under this subsection for 
any period of enrollment, a student shall meet the eli-
736 
† HR 1 EAS 
gibility requirements for a Federal Pell Grant under 
this section, except that the student— 
‘‘(A) shall be enrolled, or accepted for enroll-
ment, in an eligible program under section 
481(b)(3) (hereinafter referred to as an ‘eligible 
workforce program’); and 
‘‘(B) may not— 
‘‘(i) be enrolled, or accepted for enroll-
ment, in a program of study that leads to 
a graduate credential; or 
‘‘(ii) have attained such a credential. 
‘‘(3) TERMS AND CONDITIONS OF AWARDS.—The 
Secretary shall award Workforce Pell Grants under 
this subsection in the same manner and with the 
same terms and conditions as the Secretary awards 
Federal Pell Grants under this section, except that— 
‘‘(A) each use of the term ‘eligible program’ 
(except in subsection (b)(9)(A)) shall be sub-
stituted by ‘eligible workforce program under sec-
tion 481(b)(3)’; 
‘‘(B) the provisions of subsection (d)(2) 
shall not be applicable to eligible workforce pro-
grams; and 
‘‘(C) a student who is eligible for a grant 
equal to less than the amount of the minimum
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† HR 1 EAS 
Federal Pell Grant because the eligible workforce 
program in which the student is enrolled or ac-
cepted for enrollment is less than an academic 
year (in hours of instruction or weeks of dura-
tion) may still be eligible for a Workforce Pell 
Grant in an amount that is prorated based on 
the length of the program. 
‘‘(4) PREVENTION OF DOUBLE BENEFITS.—No el-
igible student described in paragraph (2) may con-
currently receive a grant under both this subsection 
and— 
‘‘(A) subsection (b); or 
‘‘(B) subsection (c). 
‘‘(5) DURATION LIMIT.—Any period of study cov-
ered by a Workforce Pell Grant awarded under this 
subsection shall be included in determining a stu-
dent’s duration limit under subsection (d)(5).’’. 
(b) PROGRAM ELIGIBILITY
FOR WORKFORCE PELL 
GRANTS.—Section 481(b) of the Higher Education Act of 
1965 (20 U.S.C. 1088(b)) is amended— 
(1) by redesignating paragraphs (3) and (4) as 
paragraphs (4) and (5), respectively; and 
(2) by inserting after paragraph (2) the fol-
lowing:
738 
† HR 1 EAS 
‘‘(3)(A) A program is an eligible program for 
purposes of the Workforce Pell Grant program under 
section 401(k) only if— 
‘‘(i) it is a program of at least 150 clock 
hours of instruction, but less than 600 clock 
hours of instruction, or an equivalent number of 
credit hours, offered by an eligible institution 
during a minimum of 8 weeks, but less than 15 
weeks; 
‘‘(ii) it is not offered as a correspondence 
course, as defined in 600.2 of title 34, Code of 
Federal Regulations (as in effect on July 1, 
2021); 
‘‘(iii) the Governor of a State, after con-
sultation with the State board, determines that 
the program— 
‘‘(I) provides an education aligned 
with the requirements of high-skill, high- 
wage (as identified by the State pursuant to 
section 122 of the Carl D. Perkins Career 
and Technical Education Act (20 U.S.C. 
2342)), or in-demand industry sectors or oc-
cupations;
739 
† HR 1 EAS 
‘‘(II) meets the hiring requirements of 
potential employers in the sectors or occu-
pations described in subclause (I); 
‘‘(III) either— 
‘‘(aa) leads to a recognized post-
secondary credential that is stackable 
and portable across more than one em-
ployer; or 
‘‘(bb) with respect to students en-
rolled in the program— 
‘‘(AA) prepares such students 
for employment in an occupation 
for which there is only one recog-
nized 
postsecondary 
credential; 
and 
‘‘(BB) provides such students 
with such a credential upon com-
pletion of such program; and 
‘‘(IV) prepares students to pursue 1 or 
more certificate or degree programs at 1 or 
more institutions of higher education (which 
may include the eligible institution pro-
viding the program), including by ensur-
ing—
740 
† HR 1 EAS 
‘‘(aa) that a student, upon com-
pletion of the program and enrollment 
in such a related certificate or degree 
program, will receive academic credit 
for the Workforce Pell program that 
will be accepted toward meeting such 
certificate or degree program require-
ments; and 
‘‘(bb) the acceptability of such 
credit toward meeting such certificate 
or degree program requirements; and 
‘‘(iv) after the Governor of such State makes 
the determination that the program meets the re-
quirements under clause (iii), the Secretary de-
termines that— 
‘‘(I) the program has been offered by 
the eligible institution for not less than 1 
year prior to the date on which the Sec-
retary makes a determination under this 
clause; 
‘‘(II) for each award year, the program 
has a verified completion rate of at least 70 
percent, within 150 percent of the normal 
time for completion;
741 
† HR 1 EAS 
‘‘(III) for each award year, the pro-
gram has a verified job placement rate of at 
least 70 percent, measured 180 days after 
completion; and 
‘‘(IV) for each award year, the total 
amount of the published tuition and fees of 
the program for such year is an amount 
that does not exceed the value-added earn-
ings of students who received Federal finan-
cial aid under this title and who completed 
the program 3 years prior to the award 
year, as such earnings are determined by 
calculating the difference between— 
‘‘(aa) the median earnings of such 
students, as adjusted by the State and 
metropolitan area regional price pari-
ties of the Bureau of Economic Anal-
ysis based on the location of such pro-
gram; and 
‘‘(bb) 150 percent of the poverty 
line applicable to a single individual 
as determined under section 673(2) of 
the Community Services Block Grant 
Act (42 U.S.C. 9902(2)) for such year. 
‘‘(B) In this paragraph:
742 
† HR 1 EAS 
‘‘(i) The term ‘eligible institution’ means an 
eligible institution for purposes of section 401. 
‘‘(ii) The term ‘Governor’ means the chief 
executive of a State. 
‘‘(iii) The terms ‘in-demand industry sector 
or occupation’, ‘recognized postsecondary creden-
tial’, and ‘State board’ have the meanings given 
such terms in section 3 of the Workforce Innova-
tion and Opportunity Act.’’. 
(c) EFFECTIVE DATE; APPLICABILITY.—The amend-
ments made by this section shall take effect on July 1, 2026, 
and shall apply with respect to award year 2026–2027 and 
each succeeding award year. 
SEC. 83003. PELL SHORTFALL. 
Section 401(b)(7)(A)(iii) of the Higher Education Act 
of 1965 (20 U.S.C. 1070a(b)(7)(A)(iii)) is amended by 
striking 
‘‘$2,170,000,000’’ 
and 
inserting 
‘‘$12,670,000,000’’. 
SEC. 83004. FEDERAL PELL GRANT EXCLUSION RELATING 
TO OTHER GRANT AID. 
Section 401(d) of the Higher Education Act of 1965 
(20 U.S.C. 1070a(d)) is amended by adding at the end the 
following: 
‘‘(6) EXCLUSION.—Beginning on July 1, 2026, 
and notwithstanding this subsection or subsection (b),
743 
† HR 1 EAS 
a student shall not be eligible for a Federal Pell 
Grant under subsection (b) during any period for 
which the student receives grant aid from non-Federal 
sources, including States, institutions of higher edu-
cation, or private sources, in an amount that equals 
or exceeds the student’s cost of attendance for such pe-
riod.’’. 
Subtitle E—Accountability 
SEC. 84001. INELIGIBILITY BASED ON LOW EARNING OUT-
COMES. 
Section 454 of the Higher Education Act of 1965 (20 
U.S.C. 1087d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (5), by striking ‘‘and’’ 
after the semicolon; 
(B) by redesignating paragraph (6) as 
paragraph (7); and 
(C) by inserting after paragraph (5) the fol-
lowing: 
‘‘(6) provide assurances that, beginning July 1, 
2026, the institution will comply with all require-
ments of subsection (c); and’’; 
(2) in subsection (b)(2), by striking ‘‘and (6)’’ 
and inserting ‘‘(6), and (7)’’;
744 
† HR 1 EAS 
(3) by redesignating subsection (c) as subsection 
(d); and 
(4) by inserting after subsection (b) the fol-
lowing: 
‘‘(c) INELIGIBILITY FOR CERTAIN PROGRAMS BASED 
ON LOW EARNING OUTCOMES.— 
‘‘(1) IN
GENERAL.—Notwithstanding section 
481(b), an institution of higher education subject to 
this subsection shall not use funds under this part for 
student enrollment in an educational program offered 
by the institution that is described in paragraph (2). 
‘‘(2) LOW-EARNING
OUTCOME
PROGRAMS
DE-
SCRIBED.—An educational program at an institution 
is described in this paragraph if the program awards 
an undergraduate degree, graduate or professional de-
gree, or graduate certificate, for which the median 
earnings (as determined by the Secretary) of the pro-
grammatic cohort of students who received funds 
under this title for enrollment in such program, who 
completed such program during the academic year 
that is 4 years before the year of the determination, 
who are not enrolled in any institution of higher edu-
cation, and who are working, are, for not less than 
2 of the 3 years immediately preceding the date of the 
determination, less than the median earnings of a
745 
† HR 1 EAS 
working adult described in paragraph (3) for the cor-
responding year. 
‘‘(3) CALCULATION OF MEDIAN EARNINGS.— 
‘‘(A) WORKING
ADULT.—For purposes of 
applying paragraph (2) to an educational pro-
gram at an institution, a working adult de-
scribed in this paragraph is a working adult 
who, for the corresponding year— 
‘‘(i) is aged 25 to 34; 
‘‘(ii) is not enrolled in an institution 
of higher education; and 
‘‘(iii)(I) in the case of a determination 
made for an educational program that 
awards a baccalaureate or lesser degree, has 
only a high school diploma or its recognized 
equivalent; or 
‘‘(II) in the case of a determination 
made for a graduate or professional pro-
gram, has only a baccalaureate degree. 
‘‘(B) SOURCE OF DATA.—For purposes of 
applying paragraph (2) to an educational pro-
gram at an institution, the median earnings of 
a working adult, as described in subparagraph 
(A), shall be based on data from the Bureau of 
the Census—
746 
† HR 1 EAS 
‘‘(i) with respect to an educational 
program that awards a baccalaureate or 
lesser degree— 
‘‘(I) for the State in which the in-
stitution is located; or 
‘‘(II) if fewer than 50 percent of 
the students enrolled in the institution 
reside in the State where the institu-
tion is located, for the entire United 
States; and 
‘‘(ii) with respect to an educational 
program that is a graduate or professional 
program— 
‘‘(I) for the lowest median earn-
ings of— 
‘‘(aa) a working adult in the 
State in which the institution is 
located; 
‘‘(bb) a working adult in the 
same field of study (as determined 
by the Secretary, such as by using 
the 2-digit CIP code) in the State 
in which the institution is located; 
and
747 
† HR 1 EAS 
‘‘(cc) a working adult in the 
same field of study (as so deter-
mined) in the entire United 
States; or 
‘‘(II) if fewer than 50 percent of 
the students enrolled in the institution 
reside in the State where the institu-
tion is located, for the lower median 
earnings of— 
‘‘(aa) a working adult in the 
entire United States; or 
‘‘(bb) a working adult in the 
same field of study (as so deter-
mined) in the entire United 
States. 
‘‘(4) SMALL PROGRAMMATIC COHORTS.—For any 
year for which the programmatic cohort described in 
paragraph (2) for an educational program of an in-
stitution is fewer than 30 individuals, the Secretary 
shall— 
‘‘(A) first, aggregate additional years of 
programmatic data in order to achieve a cohort 
of at least 30 individuals; and 
‘‘(B) second, in cases in which the cohort 
(including the individuals added under subpara-
748 
† HR 1 EAS 
graph (A)) is still fewer than 30 individuals, ag-
gregate additional cohort years of programmatic 
data for educational programs of equivalent 
length in order to achieve a cohort of at least 30 
individuals. 
‘‘(5) APPEALS PROCESS.—An educational pro-
gram shall not lose eligibility under this subsection 
unless the institution has had the opportunity to ap-
peal the programmatic median earnings of students 
working and not enrolled determination under para-
graph (2), through a process established by the Sec-
retary. During such appeal, the Secretary may per-
mit the educational program to continue to partici-
pate in the program under this part. 
‘‘(6) NOTICE TO STUDENTS.— 
‘‘(A) IN GENERAL.—If an educational pro-
gram of an institution of higher education sub-
ject to this subsection does not meet the cohort 
median earning requirements, as described in 
paragraph (2), for one year during the applica-
ble covered period but has not yet failed to meet 
such requirements for 2 years during such cov-
ered period, the institution shall promptly in-
form each student enrolled in the educational 
program of the eligible program’s low cohort me-
749 
† HR 1 EAS 
dian earnings and that the educational program 
is at risk of losing its eligibility for funds under 
this part. 
‘‘(B) COVERED
PERIOD.—In this para-
graph, the term ‘covered period’ means the pe-
riod of the 3 years immediately preceding the 
date of a determination made under paragraph 
(2). 
‘‘(7) REGAINING PROGRAMMATIC ELIGIBILITY.— 
The Secretary shall establish a process by which an 
institution of higher education that has an edu-
cational program that has lost eligibility under this 
subsection may, after a period of not less than 2 years 
of such program’s ineligibility, apply to regain such 
eligibility, subject to the requirements established by 
the Secretary that further the purpose of this sub-
section.’’. 
Subtitle F—Regulatory Relief 
SEC. 85001. DELAY OF RULE RELATING TO BORROWER DE-
FENSE TO REPAYMENT. 
(a) DELAY.—Beginning on the date of enactment of 
this section, for loans that first originate before July 1, 
2035, the provisions of subpart D of part 685 of title 34, 
Code of Federal Regulations (relating to borrower defense 
to repayment), as added or amended by the final regula-
750 
† HR 1 EAS 
tions published by the Department of Education on Novem-
ber 1, 2022, and titled ‘‘Institutional Eligibility Under the 
Higher Education Act of 1965, as Amended; Student Assist-
ance General Provisions; Federal Perkins Loan Program; 
Federal Family Education Loan Program; and William D. 
Ford Federal Direct Loan Program’’ (87 Fed. Reg. 65904) 
shall not be in effect. 
(b) EFFECT.—Beginning on the date of enactment of 
this section, with respect to loans that first originate before 
July 1, 2035, any regulations relating to borrower defense 
to repayment that took effect on July 1, 2020, are restored 
and revived as such regulations were in effect on such date. 
SEC. 85002. DELAY OF RULE RELATING TO CLOSED SCHOOL 
DISCHARGES. 
(a) DELAY.—Beginning on the date of enactment of 
this section, for loans that first originate before July 1, 
2035, the provisions of sections 674.33(g), 682.402(d), and 
685.214 of title 34, Code of Federal Regulations (relating 
to closed school discharges), as added or amended by the 
final regulations published by the Department of Education 
on November 1, 2022, and titled ‘‘Institutional Eligibility 
Under the Higher Education Act of 1965, as Amended; Stu-
dent Assistance General Provisions; Federal Perkins Loan 
Program; Federal Family Education Loan Program; and
751 
† HR 1 EAS 
William D. Ford Federal Direct Loan Program’’ (87 Fed. 
Reg. 65904), shall not be in effect. 
(b) EFFECT.—Beginning on the date of enactment of 
this section, with respect to loans that first originate before 
July 1, 2035, the portions of the Code of Federal Regula-
tions described in subsection (a) and amended by the final 
regulations described in subsection (a) shall be in effect as 
if the amendments made by such final regulations had not 
been made. 
Subtitle G—Garden of Heroes 
SEC. 86001. GARDEN OF HEROES. 
In addition to amounts otherwise available, there are 
appropriated to the National Endowment for the Human-
ities for fiscal year 2025, out of any money in the Treasury 
not otherwise appropriated, to remain available through fis-
cal year 2028, $40,000,000 for the procurement of statues 
as described in Executive Order 13934 (85 Fed. Reg. 41165; 
relating to building and rebuilding monuments to Amer-
ican heroes), Executive Order 13978 (86 Fed. Reg. 6809; 
relating to building the National Garden of American He-
roes), and Executive Order 14189 (90 Fed. Reg. 8849; relat-
ing to celebrating America’s birthday).
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† HR 1 EAS 
Subtitle H—Office of Refugee 
Resettlement 
SEC. 87001. POTENTIAL SPONSOR VETTING FOR UNACCOM-
PANIED ALIEN CHILDREN APPROPRIATION. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Office of Refugee 
Resettlement for fiscal year 2025, out of any money in the 
Treasury not otherwise appropriated, $300,000,000, to re-
main available until September 30, 2028, for the purposes 
described in subsection (b). 
(b) USE OF FUNDS.—The funds made available under 
subsection (a) may only be used for the Office of Refugee 
Resettlement to support costs associated with— 
(1) background checks on potential sponsors, 
which shall include— 
(A) the name of the potential sponsor and 
of all adult residents of the potential sponsor’s 
household; 
(B) the social security number or tax payer 
identification number of the potential sponsor 
and of all adult residents of the potential spon-
sor’s household; 
(C) the date of birth of the potential sponsor 
and of all adult residents of the potential spon-
sor’s household;
753 
† HR 1 EAS 
(D) the validated location of the residence 
at which the unaccompanied alien child will be 
placed; 
(E) an in-person or virtual interview with, 
and suitability study concerning, the potential 
sponsor and all adult residents of the potential 
sponsor’s household; 
(F) contact information for the potential 
sponsor and for all adult residents of the poten-
tial sponsor’s household; and 
(G) the results of all background and crimi-
nal records checks for the potential sponsor and 
for all adult residents of the potential sponsor’s 
household, which shall include, at a minimum, 
an investigation of the public records sex offender 
registry, a public records background check, and 
a national criminal history check based on fin-
gerprints; 
(2) home studies of potential sponsors of unac-
companied alien children; 
(3) determining whether an unaccompanied 
alien child poses a danger to self or others by con-
ducting an examination of the unaccompanied alien 
child for gang-related tattoos and other gang-related 
markings and covering such tattoos or markings while
754 
† HR 1 EAS 
the child is in the care of the Office of Refugee Reset-
tlement; 
(4) data systems improvement and sharing that 
supports the health, safety, and well being of unac-
companied alien children by determining the appro-
priateness of potential sponsors of unaccompanied 
alien children and of adults residing in the household 
of the potential sponsor and by assisting with the 
identification and investigation of child labor exploi-
tation and child trafficking; and 
(5) coordinating and communicating with State 
child welfare agencies regarding the placement of un-
accompanied alien children in such States by the Of-
fice of Refugee Resettlement. 
(c) DEFINITIONS.—In this section: 
(1) POTENTIAL SPONSOR.—The term ‘‘potential 
sponsor’’ means an individual or entity who applies 
for the custody of an unaccompanied alien child. 
(2) UNACCOMPANIED ALIEN CHILD.—The term 
‘‘unaccompanied alien child’’ has the meaning given 
such term in section 462(g) of the Homeland Security 
Act of 2002 (6 U.S.C. 279(g)).
755 
† HR 1 EAS 
TITLE 
IX—COMMITTEE 
ON 
HOMELAND 
SECURITY 
AND 
GOVERNMENTAL AFFAIRS 
Subtitle A—Homeland Security 
Provisions 
SEC. 90001. BORDER INFRASTRUCTURE AND WALL SYSTEM. 
In addition to amounts otherwise available, there is 
appropriated to the Commissioner of U.S. Customs and 
Border Protection for fiscal year 2025, out of any money 
in the Treasury not otherwise appropriated, to remain 
available until September 30, 2029, $46,550,000,000 for 
necessary expenses relating to the following elements of the 
border infrastructure and wall system: 
(1) Construction, installation, or improvement of 
new or replacement primary, waterborne, and sec-
ondary barriers. 
(2) Access roads. 
(3) Barrier system attributes, including cameras, 
lights, sensors, and other detection technology. 
(4) Any work necessary to prepare the ground at 
or near the border to allow U.S. Customs and Border 
Protection to conduct its operations, including the 
construction and maintenance of the barrier system.
756 
† HR 1 EAS 
SEC. 90002. U.S. CUSTOMS AND BORDER PROTECTION PER-
SONNEL, FLEET VEHICLES, AND FACILITIES. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Commissioner of U.S. 
Customs and Border Protection for fiscal year 2025, out 
of any money in the Treasury not otherwise appropriated, 
the following: 
(1) PERSONNEL.—$4,100,000,000, to remain 
available until September 30, 2029, to hire and train 
additional Border Patrol agents, Office of Field Oper-
ations officers, Air and Marine agents, rehired annu-
itants, and U.S. Customs and Border Protection field 
support personnel. 
(2) RETENTION, HIRING, AND PERFORMANCE BO-
NUSES.—$2,052,630,000, to remain available until 
September 30, 2029, to provide recruitment bonuses, 
performance awards, or annual retention bonuses to 
eligible Border Patrol agents, Office of Field Oper-
ations officers, and Air and Marine agents. 
(3) VEHICLES.—$855,000,000, to remain avail-
able until September 30, 2029, for the repair of exist-
ing patrol units and the lease or acquisition of addi-
tional patrol units. 
(4) FACILITIES.—$5,000,000,000 for necessary 
expenses relating to lease, acquisition, construction, 
design, or improvement of facilities and checkpoints
757 
† HR 1 EAS 
owned, leased, or operated by U.S. Customs and Bor-
der Protection. 
(b) RESTRICTION.—None of the funds made available 
by subsection (a) may be used to recruit, hire, or train per-
sonnel for the duties of processing coordinators after October 
31, 2028. 
SEC. 90003. DETENTION CAPACITY. 
(a) IN GENERAL.—In addition to any amounts other-
wise appropriated, there is appropriated to U.S. Immigra-
tion and Customs Enforcement for fiscal year 2025, out of 
any money in the Treasury not otherwise appropriated, to 
remain 
available 
until 
September 
30, 
2029, 
$45,000,000,000, for single adult alien detention capacity 
and family residential center capacity. 
(b) DURATION AND STANDARDS.—Aliens may be de-
tained at family residential centers, as described in sub-
section (a), pending a decision, under the Immigration and 
Nationality Act (8 U.S.C. 1101 et seq.), on whether the 
aliens are to be removed from the United States and, if such 
aliens are ordered removed from the United States, until 
such aliens are removed. The detention standards for the 
single adult detention capacity described in subsection (a) 
shall be set in the discretion of the Secretary of Homeland 
Security, consistent with applicable law.
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(c) DEFINITION OF FAMILY RESIDENTIAL CENTER.— 
In this section, the term ‘‘family residential center’’ means 
a facility used by the Department of Homeland Security 
to detain family units of aliens (including alien children 
who are not unaccompanied alien children (as defined in 
section 462(g) of the Homeland Security Act of 2002 (6 
U.S.C. 279(g)))) who are encountered or apprehended by 
the Department of Homeland Security. 
SEC. 
90004. 
BORDER 
SECURITY, 
TECHNOLOGY, 
AND 
SCREENING. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Commissioner of U.S. 
Customs and Border Protection for fiscal year 2025, out 
of any money in the Treasury not otherwise appropriated, 
to 
remain 
available 
until 
September 
30, 
2029, 
$6,168,000,000 for the following: 
(1) Procurement and integration of new non-
intrusive inspection equipment and associated civil 
works, including artificial intelligence, machine 
learning, and other innovative technologies, as well as 
other mission support, to combat the entry or exit of 
illicit narcotics at ports of entry and along the south-
west, northern, and maritime borders.
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(2) Air and Marine operations’ upgrading and 
procurement of new platforms for rapid air and ma-
rine response capabilities. 
(3) Upgrades and procurement of border surveil-
lance technologies along the southwest, northern, and 
maritime borders. 
(4) Necessary expenses, including the deployment 
of technology, relating to the biometric entry and exit 
system under section 7208 of the Intelligence Reform 
and Terrorism Prevention Act of 2004 (8 U.S.C. 
1365b). 
(5) Screening persons entering or exiting the 
United States. 
(6) Initial screenings of unaccompanied alien 
children (as defined in section 462(g) of the Home-
land Security Act of 2002 (6 U.S.C. 279(g))), con-
sistent with the William Wilberforce Trafficking Vic-
tims Protection Reauthorization Act of 2008 (Public 
Law 110–457; 122 Stat. 5044). 
(7) Enhancing border security by combating 
drug trafficking, including fentanyl and its precursor 
chemicals, at the southwest, northern, and maritime 
borders. 
(8) Commemorating efforts and events related to 
border security.
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† HR 1 EAS 
(b) RESTRICTIONS.—None of the funds made available 
under subsection (a) may be used for the procurement or 
deployment of surveillance towers along the southwest bor-
der and northern border that have not been tested and ac-
cepted by U.S. Customs and Border Protection to deliver 
autonomous capabilities. 
(c) DEFINITION OF AUTONOMOUS.—In this section, 
with respect to capabilities, the term ‘‘autonomous’’ means 
a system designed to apply artificial intelligence, machine 
learning, computer vision, or other algorithms to accurately 
detect, identify, classify, and track items of interest in real 
time such that the system can make operational adjust-
ments without the active engagement of personnel or contin-
uous human command or control. 
SEC. 90005. STATE AND LOCAL ASSISTANCE. 
(a) STATE
HOMELAND
SECURITY
GRANT
PRO-
GRAMS.— 
(1) IN GENERAL.—In addition to amounts other-
wise available, there is appropriated to the Adminis-
trator of the Federal Emergency Management Agency 
for fiscal year 2025, out of any money in the Treas-
ury not otherwise appropriated, to remain available 
until September 30, 2029, to be administered under 
the State Homeland Security Grant Program author-
ized under section 2004 of the Homeland Security Act
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† HR 1 EAS 
of 2002 (6 U.S.C. 605), to enhance State, local, and 
Tribal security through grants, contracts, cooperative 
agreements, and other activities— 
(A) $500,000,000 for State and local capa-
bilities to detect, identify, track, or monitor 
threats from unmanned aircraft systems (as such 
term is defined in section 44801 of title 49, 
United States Code), consistent with titles 18 
and 49 of the United States Code; 
(B) $625,000,000 for security and other 
costs related to the 2026 FIFA World Cup; 
(C) $1,000,000,000 for security, planning, 
and other costs related to the 2028 Olympics; 
and 
(D) 
$450,000,000 
for 
the 
Operation 
Stonegarden Grant Program. 
(2) TERMS AND CONDITIONS.—None of the funds 
made available under subparagraph (B) or (C) of 
paragraph (1) shall be subject to the requirements of 
section 2004(e)(1) or section 2008(a)(12) of the Home-
land Security Act of 2002 (6 U.S.C. 605(e)(1), 
609(a)(12)). 
(b) STATE
BORDER
SECURITY
REINFORCEMENT 
FUND.—
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† HR 1 EAS 
(1) ESTABLISHMENT.—There is established, in 
the Department of Homeland Security, a fund to be 
known as the ‘‘State Border Security Reinforcement 
Fund.’’ 
(2) PURPOSES.—The Secretary of Homeland Se-
curity shall use amounts appropriated or otherwise 
made available for the Fund for grants to eligible 
States and units of local government for any of the 
following purposes: 
(A) Construction or installation of a border 
wall, border fencing or other barrier, or buoys 
along the southern border of the United States, 
which may include planning, procurement of 
materials, and personnel costs related to such 
construction or installation. 
(B) Any work necessary to prepare the 
ground at or near land borders to allow con-
struction and maintenance of a border wall or 
other barrier fencing. 
(C) Detection and interdiction of illicit sub-
stances and aliens who have unlawfully entered 
the United States and have committed a crime 
under Federal, State, or local law, and transfer 
or referral of such aliens to the Department of 
Homeland Security as provided by law.
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† HR 1 EAS 
(D) Relocation of aliens who are unlawfully 
present in the United States from small popu-
lation centers to other domestic locations. 
(3) APPROPRIATION.—In addition to amounts 
otherwise available for the purposes described in 
paragraph (2), there is appropriated for fiscal year 
2025, out of any money in the Treasury not otherwise 
appropriated, to the Department of Homeland Secu-
rity for the State Border Security Reinforcement 
Fund established by paragraph (1), $10,000,000,000, 
to remain available until September 30, 2034, for 
qualified expenses for such purposes. 
(4) ELIGIBILITY.—The Secretary of Homeland 
Security may provide grants from the fund estab-
lished by paragraph (1) to State agencies and units 
of local governments for expenditures made for com-
pleted, ongoing, or new activities, in accordance with 
law, that occurred on or after January 20, 2021. 
(5) APPLICATION.—Each State desiring to apply 
for a grant under this subsection shall submit an ap-
plication to the Secretary containing such informa-
tion in support of the application as the Secretary 
may require. The Secretary shall require that each 
State include in its application the purposes for 
which the State seeks the funds and a description of
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† HR 1 EAS 
how the State plans to allocate the funds. The Sec-
retary shall begin to accept applications not later 
than 90 days after the date of the enactment of this 
Act. 
(6) TERMS AND CONDITIONS.—Nothing in this 
subsection shall authorize any State or local govern-
ment to exercise immigration or border security au-
thorities reserved exclusively to the Federal Govern-
ment under the Immigration and Nationality Act (8 
U.S.C. 1101 et seq.) or the Homeland Security Act of 
2002 (6 U.S.C. 101 et seq.). The Federal Emergency 
Management Agency may use not more than 1 per-
cent of the funds made available under this subsection 
for the purpose of administering grants provided for 
in this section. 
SEC. 90006. PRESIDENTIAL RESIDENCE PROTECTION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Administrator of the 
Federal Emergency Management Agency for fiscal year 
2025, out of any money in the Treasury not otherwise ap-
propriated, $300,000,000, to remain available until Sep-
tember 30, 2029, for the reimbursement of extraordinary 
law enforcement personnel costs for protection activities di-
rectly and demonstrably associated with any residence of 
the President designated pursuant to section 3 or 4 of the
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† HR 1 EAS 
Presidential Protection Assistance Act of 1976 (Public Law 
94–524; 18 U.S.C. 3056 note) to be secured by the United 
States Secret Service. 
(b) AVAILABILITY.—Funds appropriated under this 
section shall be available only for costs that a State or local 
agency— 
(1) incurred or incurs on or after July 1, 2024; 
(2) demonstrates to the Administrator of the 
Federal Emergency Management Agency as being— 
(A) in excess of typical law enforcement op-
eration costs; 
(B) directly attributable to the provision of 
protection described in this section; and 
(C) associated with a nongovernmental 
property designated pursuant to section 3 or 4 
of the Presidential Protection Assistance Act of 
1976 (Public Law 94–524; 18 U.S.C. 3056 note) 
to be secured by the United States Secret Service; 
and 
(3) certifies to the Administrator as compen-
sating protection activities requested by the United 
States Secret Service. 
(c) TERMS AND CONDITIONS.—The Federal Emergency 
Management Agency may use not more than 3 percent of
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† HR 1 EAS 
the funds made available under this section for the purpose 
of administering grants provided for in this section. 
SEC. 90007. DEPARTMENT OF HOMELAND SECURITY APPRO-
PRIATIONS FOR BORDER SUPPORT. 
In addition to amounts otherwise available, there are 
appropriated to the Secretary of Homeland Security for fis-
cal year 2025, out of any money in the Treasury not other-
wise appropriated, $10,000,000,000, to remain available 
until September 30, 2029, for reimbursement of costs in-
curred in undertaking activities in support of the Depart-
ment of Homeland Security’s mission to safeguard the bor-
ders of the United States. 
Subtitle B—Governmental Affairs 
Provisions 
SEC. 90101. FEHB IMPROVEMENTS. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘FEHB Protection Act of 2025’’. 
(b) DEFINITIONS.—In this section: 
(1) DIRECTOR.—The term ‘‘Director’’ means the 
Director of the Office of Personnel Management. 
(2) HEALTH BENEFITS PLAN; MEMBER OF FAM-
ILY.—The terms ‘‘health benefits plan’’ and ‘‘member 
of family’’ have the meanings given those terms in 
section 8901 of title 5, United States Code.
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† HR 1 EAS 
(3) OPEN
SEASON.—The term ‘‘open season’’ 
means an open season described in section 890.301(f) 
of title 5, Code of Federal Regulations, or any suc-
cessor regulation. 
(4) PROGRAM.—The term ‘‘Program’’ means the 
health insurance programs carried out under chapter 
89 of title 5, United States Code, including the pro-
gram carried out under section 8903c of that title. 
(5) QUALIFYING LIFE EVENT.—The term ‘‘quali-
fying life event’’ has the meaning given the term in 
section 892.101 of title 5, Code of Federal Regula-
tions, or any successor regulation. 
(c) VERIFICATION REQUIREMENTS.—Not later than 1 
year after the date of enactment of this Act, the Director 
shall issue regulations and implement a process to verify— 
(1) the veracity of any qualifying life event 
through which an enrollee in the Program seeks to 
add a member of family with respect to the enrollee 
to a health benefits plan under the Program; and 
(2) that, when an enrollee in the Program seeks 
to add a member of family with respect to the enrollee 
to the health benefits plan of the enrollee under the 
Program, including during any open season, the indi-
vidual so added is a qualifying member of family 
with respect to the enrollee.
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† HR 1 EAS 
(d) FRAUD RISK ASSESSMENT.—In any fraud risk as-
sessment conducted with respect to the Program on or after 
the date of enactment of this Act, the Director shall include 
an assessment of individuals who are enrolled in, or covered 
under, a health benefits plan under the Program even 
though those individuals are not eligible to be so enrolled 
or covered. 
(e) FAMILY
MEMBER
ELIGIBILITY
VERIFICATION 
AUDIT.— 
(1) IN GENERAL.—During the 3-year period be-
ginning on the date that is 1 year after the date of 
enactment of this Act, the Director shall carry out a 
comprehensive audit regarding members of family 
who are covered under an enrollment in a health ben-
efits plan under the Program. 
(2) CONTENTS.—With respect to the audit car-
ried out under paragraph (1), the Director shall re-
view marriage certificates, birth certificates, and 
other appropriate documents that are necessary to de-
termine eligibility to enroll in a health benefits plan 
under the Program. 
(f) DISENROLLMENT OR REMOVAL.—Not later than 
180 days after the date of enactment of this Act, the Direc-
tor shall develop a process by which any individual enrolled 
in, or covered under, a health benefits plan under the Pro-
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† HR 1 EAS 
gram who is not eligible to be so enrolled or covered shall 
be disenrolled or removed from enrollment in, or coverage 
under, that health benefits plan. 
(g) EARNED BENEFITS AND HEALTH CARE ADMINIS-
TRATIVE SERVICES ASSOCIATED OVERSIGHT AND AUDIT 
FUNDING.—Section 8909 of title 5, United States Code, is 
amended— 
(1) in subsection (a)(2), by inserting before the 
period at the end the following: ‘‘, except that the 
amounts required to be set aside under subsection 
(b)(2) shall not be subject to the limitations that may 
be specified annually by Congress’’; and 
(2) in subsection (b)— 
(A) by redesignating paragraph (2) as 
paragraph (3); and 
(B) by inserting after paragraph (1) the fol-
lowing: 
‘‘(2) In fiscal year 2026, $66,000,000, to be de-
rived from all contributions, and to remain available 
until the end of fiscal year 2035, for the Director of 
the Office to carry out subsections (c) through (f) of 
the FEHB Protection Act of 2025.’’.
770 
† HR 1 EAS 
SEC. 90102. PANDEMIC RESPONSE ACCOUNTABILITY COM-
MITTEE. 
(a) PANDEMIC
RESPONSE
ACCOUNTABILITY
COM-
MITTEE FUNDING AVAILABILITY.—In addition to amounts 
otherwise available, there is appropriated for fiscal year 
2026, out of any money in the Treasury not otherwise ap-
propriated, $88,000,000, to remain available until ex-
pended, for the Pandemic Response Accountability Com-
mittee to support oversight of the Coronavirus response and 
of funds provided in this Act or any other Act pertaining 
to the Coronavirus pandemic. 
(b) CARES ACT.—Section 15010 of the CARES Act 
(Public Law 116–136; 134 Stat. 533) is amended— 
(1) in subsection (a)(6)— 
(A) in subparagraph (E), by striking ‘‘or’’ 
at the end; 
(B) in subparagraph (F), by striking ‘‘and’’ 
at the end and inserting ‘‘or’’; and 
(C) by adding at the end the following: 
‘‘(G) the Act titled ‘An Act to provide for 
reconciliation pursuant to title II of H. Con. 
Res. 14’; and’’; and 
(2) in subsection (k), by striking ‘‘2025’’ and in-
serting ‘‘2034’’.