II 119th CONGRESS 1st Session S. 2244 IN THE SENATE OF THE UNITED STATES July 10, 2025 Mr. Paul introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To require immediate changes to Medicaid relating to alien eligibility and payments to Medicaid expansion States that furnish health care to certain aliens.

1. Short title This Act may be cited as the Excluding Illegal Aliens from Medicaid Act . 2. Change of effective date for alien Medicaid eligibility (a) In general Section 1903(v)(5) of the Social Security Act ( 42 U.S.C. 1396b(v)(5) ), as added by section 71109(a) of an Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 ( Public Law 119–21 ), is amended by striking October 1, 2026 and inserting July 4, 2025 . (b) Effective date The amendment made by subsection (a) shall take effect as if included in the enactment of section 71109 of an Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 ( Public Law 119–21 ). 3. Expansion FMAP for certain States providing payments for health care furnished to certain individuals Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— (1) in subsection (y)— (A) in paragraph (1)(E), by inserting (or, for calendar quarters beginning on or after July 4, 2025, in the case such State is a specified State with respect to such calendar quarter, the Federal medical assistance percentage determined under subsection (b) for such State) after thereafter ; and (B) in paragraph (2), by adding at the end the following new subparagraph: (C) Specified State The term specified State means, with respect to a quarter, a State that— (i) provides any form of financial assistance from a State general fund during such quarter, in whole or in part, whether or not made under a State plan (or waiver of such plan) under this title or under another program established by the State, to or on behalf of an alien who is not a qualified alien and is not a child or pregnant woman who is lawfully residing in the United States and eligible for medical assistance pursuant to section 1903(v)(4) or for child health assistance or pregnancy-related assistance pursuant to section 2107(e)(1)(Q), for the purchasing of health insurance coverage (as defined in section 2791(b)(1) of the Public Health Service Act) for an alien who is not a qualified alien and is not such a child or pregnant woman; or (ii) provides any form of comprehensive health benefits coverage, except such coverage required by Federal law, during such quarter, whether or not under a State plan (or waiver of such plan) under this title or under another program established by the State, and regardless of the source of funding for such coverage, to an alien who is not a qualified alien and is not such a child or pregnant woman. (D) Immigration terms (i) Alien The term alien has the meaning given such term in section 101(a) of the Immigration and Nationality Act. (ii) Qualified alien The term qualified alien has the meaning given such term in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, except that the references to (in the opinion of the agency providing such benefits) in subsection (c) of such section 431 shall be treated as references to (in the opinion of the State in which such comprehensive health benefits coverage or such financial assistance is provided, as applicable) . ; and (2) in subsection (z)(2)— (A) in subparagraph (A), by striking for such year and inserting for such quarter ; and (B) in subparagraph (B)(i)— (i) in the matter preceding subclause (I), by striking for a year and inserting for a calendar quarter in a year ; and (ii) in subclause (II), by striking for the year and inserting for the quarter for the State .