Bills · HR 497
IN COMMITTEE· 119TH CONGRESS
House BillHR 497State and local government operationsMedicaid
Medicaid Third Party Liability Act
INTRO JAN 16· LAST ACTION JAN 16
READING
5MIN
COSPONSORS
0
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
- Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-writtenThis bill matters because it seeks to reduce the financial burden on the Medicaid program by ensuring that other responsible parties, especially private health insurers, pay their share of healthcare costs. If passed, it could shift more costs away from state and federal Medicaid budgets and onto other insurers, potentially freeing up Medicaid funds for other uses or reducing the need for taxpayer dollars to support the program. For taxpayers, this could mean more efficient use of federal and state funds.
The current relevance lies in ongoing efforts to control healthcare spending and ensure fiscal responsibility within large government programs like Medicaid. If this bill becomes law, states would have stronger incentives and clearer guidelines to recover costs, and private insurers might bear more of the initial financial responsibility for services provided to individuals who are also eligible for Medicaid. If it doesn't pass, existing exemptions and practices regarding third-party liability in Medicaid would remain, potentially leaving more costs on the Medicaid program that could otherwise be covered by other insurers.
KEY PROVISIONS
5AI-extractedPROVISION 01
Removes special rules that previously allowed states to avoid recovering funds from third-party insurers for certain types of care or payments under Medicaid.
This means states will be required to pursue payment from other insurers in more situations, potentially shifting costs from Medicaid.
PROVISION 02
Allows states to delegate the responsibility of identifying and recovering payments from third-party payers to the health insurers (like managed care plans) they contract with for Medicaid services.
This could streamline the recovery process and leverage private health plans' existing systems for managing claims.
PROVISION 03
Requires states to collect and verify information about whether Medicaid applicants and beneficiaries have other health insurance coverage.
This provision ensures that states have the necessary data to identify and pursue third-party payers more effectively.
PROVISION 04
States will lose federal matching funds for medical assistance provided to individuals if they fail to collect and verify third-party insurance information after January 1, 2026.
This creates a strong financial incentive for states to comply with the new data collection requirements.
PROVISION 05
After January 1, 2026, other health insurers or responsible third parties must accept a Medicaid authorization for a service as a valid authorization for payment.
This aims to simplify the billing and payment process for providers by preventing other insurers from denying claims based on a lack of their own prior authorization.
SPONSORSHIP
1 + 0
R· Texas
YRS IN OFFICE
7
BILLS LED
24
ACTION TIMELINE
2 EVENTSJAN 16
Introduced in House
JAN 16
Referred to the House Committee on Energy and Commerce.
BILL INFO
TypeHouse Bill
NumberHR 497
Congress119th
StatusIn Committee
IntroducedJan 16, 2025
Last actionJan 16, 2025
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IN COMMITTEE· 119TH CONGRESS · ENERGY AND COMMERCE COMMITTEE · INTRODUCED JAN 16, 2025
House BillHR 497State and local government operationsMedicaid
Medicaid Third Party Liability Act
INTRODUCED JAN 16, 2025· LAST ACTION JAN 16, 2025
PASSAGE CHANCES
—%
READING
5 min
COSPONSORS
0
COMPLEXITY
Moderate
