Project 2025 Tracker / What’s done, what’s next

14. Department of Health and Human Services · Notable

Let states require Medicaid recipients to share costs

Partially done

467 14. Department of Health and Human Services

“Incentivize personal responsibility. CMS should allow states to ensure that Medicaid recipients have a stake in their personal health care and a say in decisions related to the Medicaid program.”

What has happened

  1. Partially done

    Public Law 119-21 § 71120 goes further than permitting cost sharing: from 2028-10-01 State plans must impose cost sharing greater than $0 on expansion adults with income above 100 percent of the federal poverty level, in an amount the State determines, capped at $35 per item or service, with primary care, mental health, substance use disorder, FQHC, CCBHC and rural health clinic services excluded and premiums barred. States get the discretion the Mandate wanted, inside a federal mandate they did not ask for. `partial` because it takes effect in 2028 and CMS has issued no implementing regulation.

Research log

What was searched, and what didn’t count as evidence

Research notes

  • § 71120 was read in full at https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm.
  • Overlaps #1281 (one of the most significant asks, p. 468, “Add work requirements to Medicaid”), whose Quote also covers “the ability to broaden the application of targeted premiums and cost sharing to higher-income enrollees” and which cites § 71120 alongside § 71119. Both items name the overlap; this one owns the “stake in their personal health care” reading of the p. 467 Quote, #1281 owns the work- requirement trail.
  • The pre-window baseline matters: §§ 1916 and 1916A of the Social Security Act have permitted nominal and income-scaled cost sharing since 1982 and 2005 respectively, so States were never barred outright. That is why the item is not flagged Already true — the Quote asks for a stake and a say beyond the existing nominal-charge authority, and § 71120 is the in-window movement.
Action
other
Object
Medicaid recipient cost sharing and personal responsibility
ID
1280