Statement from Rep. Jay Obernolte on Medicaid Reforms in H.R. 1

As part of a broader effort to restore fiscal responsibility to in Washington, H.R. 1 includes several commonsense reforms to strengthen Medicaid – known to us in California as Medi-Cal- which is one of the most important safety net programs in our country. These changes are not intended to reduce care or deny access. They are intended to safeguard the program for the people who depend on it and ensure that taxpayer dollars are used responsibly and effectively.  

Shockingly, under current law, many states continue to pay Medicaid managed care organizations (MCOs) for people who are deceased. H.R. 1 puts a stop to this by requiring states to routinely check Medicaid rolls against death rolls – something any responsible program should already be doing. This is a basic measure to prevent fraud, preserve program integrity, and protect taxpayers. 

H.R. 1 also closes another glaring loophole: currently, individuals who move between states can, in many cases, be enrolled in – and billed under – two different state Medicaid programs at the same time. H.R. 1 requires states to coordinate more effectively so that taxpayers are not paying twice for the same coverage. Again, this is common sense.  

In addition, H.R. 1 makes reforms to retroactive billing. Under these reforms, Medicaid can’t be charged for care delivered more than a month before someone was enrolled. This brings the program in line with how other insurance systems function and help ensure accountability.  

One of the most discussed elements of the bill is the new community engagement requirements for able-bodied adults who are not part of Medicaid’s core populations (pregnant women, children, people with disabilities, and seniors). These are very modest and flexible requirements which can be satisfied in a variety of ways such as working part-time, going to school, volunteering, or caring for a family member. There are also broad exemptions for those facing hardship, in treatment programs, or living with a disability. Let me be clear: no one is being forced off Medicaid because of these changes. These rules are designed not to punish anyone, but to make sure Medicaid is focused on helping people get healthy and, when they are able, move toward independence.  

Lastly, the bill addresses certain state-level practices – such as provider taxes and state-directed payments – that have been used inappropriately to artificially inflate how much federal funding a state receives. This bill reins in those abuses. States that played by the rules won’t see any impacts. But those that misuse the system will see modest adjustments. That is how good governance should work.  

At its heart, these reforms will preserve Medicaid – not weaken it. In fact, spending in the Medicaid program will continue to increase even after these changes. We owe it to the American people to ensure the program is sustainable, efficient, and focused on serving the most vulnerable in our community. I will continue to fight to protect Medicaid for those who need it and to make sure it remains strong for future generations of Americans.