H.R. 936 — Medicaid Improvement and State Flexibility Act of 2025

This section authorizes states to approve or renew, without HHS Secretary approval, specified Medicaid demonstration projects under new subsection (d)(4) of Section 1115 of the Social Security Act (42 U.S.C. 1315). (As background, Section 1115 authorizes the Secretary to waive Medicaid requirements for experimental, pilot, or demonstration projects likely to promote program objectives, with federal matching funds for otherwise ineligible costs.) Such projects must allow eligible Medicaid enrollees to elect annual participation and provide participants with (1) a state-determined amount on an electronic benefits transfer card for primary care services and medications; (2) a year-end cash payment equal to remaining card funds; and (3) enrollment in a state-determined catastrophic insurance program covering other services or primary care/medication services exceeding card amounts. Projects also must not increase federal Medicaid expenditures relative to no project; must not fund abortions except when necessary to save the mother's life or resulting from rape or incest; and, for approval purposes, treat references to the "Secretary" in subsection (a) as references to the "state." This section further exempts such projects from subsection (e).