H.R. 4384 — Excluding Illegal Aliens from Medicaid Act

This section advances the effective date for limitations on Medicaid eligibility for aliens, as specified in Section 1903(v)(5) of the Social Security Act (added by P.L. 119-21), to July 4, 2025 (from October 1, 2026). (Thus, the limitations apply approximately 15 months earlier.)

This section modifies the enhanced Federal Medical Assistance Percentage (FMAP) for the Medicaid expansion population under SSA section 1905(y)—which provides a 90% federal matching rate for medical assistance furnished to newly eligible adults with family incomes up to 138% of the federal poverty level (from 100% in 2014-2016, decreasing to 90% in 2020 and thereafter)—to instead apply a specified state's regular FMAP under subsection (b) (typically 50%-83%, depending on the state) for calendar quarters beginning on or after July 4, 2025. It defines a specified state as one that, during the quarter, uses state general funds to provide financial assistance for purchasing private health insurance coverage or provides comprehensive health benefits coverage (except as required by federal law) to aliens who are not qualified aliens (as defined in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, with state discretion on certain determinations) and are not lawfully residing children or pregnant women eligible for Medicaid or CHIP; it excludes from this penalty coverage for such children or pregnant women under SSA section 1903(v)(4) or CHIP section 2107(e)(1)(Q). This section makes conforming changes to subsection (z)(2) to base certain FMAP adjustments on calendar quarters rather than years.