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Medicaid Staffing Flexibility and Protection Act of 2025
To amend title XIX of the Social Security Act to allow States more flexibility with respect to using contractors to make eligibility determinations and redeterminations and conduct fair hearings on behalf of the State Medicaid plan, and for other purposes.
Summary
This bill amends federal Medicaid law to allow states to hire contractors, including private companies or other government agencies, to process eligibility applications, redetermine eligibility, and conduct fair hearings for Medicaid applicants and beneficiaries. States may use this option only if contractor agreements do not incentivize delays in processing applications or denying eligibility to otherwise qualified individuals. The bill also requires that contractors have no financial relationships with Medicaid managed care organizations operating in the state to prevent conflicts of interest.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
4 cosponsors
Money behind the sponsor
Top reported contributors to Earl L. "Buddy" Carter’s campaign committee (2024 cycle) — who funds the bill’s sponsor, not a claim about this bill. Data from FEC.
- NULL $80,924
- INTERNATIONAL AUTO LOGISTICS $7,500
- SAVANNAH PILOTS ASSOC $6,600
- HENNESSY AUTOMOBILE COMPANIES $6,600
- SADOWSKI CO $6,600
Organizations whose employees gave the most — itemized individual contributions grouped by the donor’s reported employer (FEC Schedule A). Full finance for Earl L. "Buddy" Carter → · Outside spending →
Actions (2)
- Nov 21, 2025 Referred to the House Committee on Energy and Commerce. · house
- Nov 21, 2025 Introduced in House
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Text versions (1)
Bills are re-published as they move (Introduced → Reported → Engrossed → Enrolled …). Each stage below is a separate text; pick two to see what changed. Data from Congress.gov.
Full text
IN THE HOUSE OF REPRESENTATIVES
November 21, 2025
Mr. Carter of Georgia (for himself, Mr. Davis of North Carolina, Mr. Dunn of Florida, Mr. Bacon, and Mr. Valadao) introduced the following bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to allow States more flexibility with respect to using contractors to make eligibility determinations and redeterminations and conduct fair hearings on behalf of the State Medicaid plan, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Medicaid Staffing Flexibility and Protection Act of 2025”.
SEC. 2. STATE FLEXIBILITY TO USE CONTRACTORS TO MAKE ELIGIBILITY DETERMINATIONS, REDETERMINATIONS, AND FAIR HEARINGS ON BEHALF OF A STATE.
(a) Requirements With Respect to Eligibility Determinations.— Section 1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)) is amended by inserting before the semicolon at the end the following: “, but such determinations of eligibility may be made, at the option of a State, under a contract with another State or local agency or a contractor, so long as the contract does not provide incentives for the agency or contractor to delay eligibility determinations or to deny eligibility for individuals otherwise eligible for medical assistance”.
(b) Requirements With Respect to Fair Hearings.—Section 1902(a)(3) of the Social Security Act (42 U.S.C. 1396a(a)(3)) is amended by inserting before the semicolon at the end the following: “, except that such fair hearing may be conducted, at the option of a State, under a contract with another State or local agency or a contractor, so long as such agency or contractor does not provide incentives to delay a fair hearing or to deny eligibility for an individual otherwise eligible for medical assistance”.
SEC. 3. PROHIBITING CONFLICTS OF INTEREST.
A State shall not use the flexibility provided under section 2 unless a contractor selected to conduct eligibility determinations or redeterminations pursuant to the amendments made by such section has no direct or indirect financial relationship with any Medicaid managed care organization (as defined in section 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 1396b(m)(1)(A))), including the network providers affiliated with such organization, that provides services to individuals entitled to medical assistance under title XIX of such Act (42 U.S.C. 1396 et seq.) pursuant to a contract with such State. <all>
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