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To amend title XIX of the Social Security Act to provide clarification with respect to the liability of third party payers for medical assistance paid under the Medicaid program, and for other purposes.
1/17/2025, 9:20 AM
Summary of Bill HR 497
Bill 119 HR 497, also known as the Medicaid Third Party Liability Act, aims to amend title XIX of the Social Security Act to provide clarity on the responsibility of third party payers for medical assistance paid under the Medicaid program. The bill seeks to ensure that third party payers, such as insurance companies or other entities, are held accountable for covering medical costs that should rightfully be paid by Medicaid.
The main purpose of this bill is to prevent third party payers from shifting the financial burden of medical expenses onto the Medicaid program, which is funded by taxpayers. By clarifying the liability of third party payers, the bill aims to protect the integrity of the Medicaid program and ensure that it can continue to provide essential healthcare services to low-income individuals and families.
Overall, Bill 119 HR 497 seeks to strengthen the Medicaid program by holding third party payers accountable for their share of medical costs, ultimately benefiting both Medicaid recipients and taxpayers.
The main purpose of this bill is to prevent third party payers from shifting the financial burden of medical expenses onto the Medicaid program, which is funded by taxpayers. By clarifying the liability of third party payers, the bill aims to protect the integrity of the Medicaid program and ensure that it can continue to provide essential healthcare services to low-income individuals and families.
Overall, Bill 119 HR 497 seeks to strengthen the Medicaid program by holding third party payers accountable for their share of medical costs, ultimately benefiting both Medicaid recipients and taxpayers.
Congressional Summary of HR 497
Medicaid Third Party Liability Act
This bill modifies requirements relating to Medicaid third-party liability.
Current law generally requires legally liable third parties (e.g., health insurers) to pay claims before Medicaid. However, Medicaid must pay first (and seek reimbursement from liable third parties) for claims for (1) preventive pediatric care, and (2) services for an individual for whom child support enforcement is being conducted by the state. The bill repeals these exceptions.
Current law also requires state Medicaid programs to take all reasonable measures to identify legally liable third parties. The bill specifically prohibits federal Medicaid payment for services to individuals for whom third-party insurance information was not obtained and verified by the state.
Current Status of Bill HR 497
Bill HR 497 is currently in the status of Bill Introduced since January 16, 2025. Bill HR 497 was introduced during Congress 119 and was introduced to the House on January 16, 2025. Bill HR 497's most recent activity was Referred to the House Committee on Energy and Commerce. as of January 16, 2025
Bipartisan Support of Bill HR 497
Total Number of Sponsors
1Democrat Sponsors
0Republican Sponsors
1Unaffiliated Sponsors
0Total Number of Cosponsors
0Democrat Cosponsors
0Republican Cosponsors
0Unaffiliated Cosponsors
0Policy Area and Potential Impact of Bill HR 497
Primary Policy Focus
Alternate Title(s) of Bill HR 497
To amend title XIX of the Social Security Act to provide clarification with respect to the liability of third party payers for medical assistance paid under the Medicaid program, and for other purposes.
To amend title XIX of the Social Security Act to provide clarification with respect to the liability of third party payers for medical assistance paid under the Medicaid program, and for other purposes.
Comments
Sponsors and Cosponsors of HR 497
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