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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
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.
