The cap is the Medicare rate, or 110 percent of it in other states
To provide for reconciliation pursuant to title II of H. Con. Res. 14, section 71116, Sec. 71116.
Written by .
The cap is the Medicare rate, or 110 percent of it in other states
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71116 in the PDF
What the document says
“the total payment rate for such service is limited to--”
The section requires the Secretary of Health and Human Services to revise section 438.6(c)(2)(iii) of title 42 of the Code of Federal Regulations so that for a payment for a service in a rating period beginning on or after enactment the total payment rate is capped at 100 percent of the specified total published Medicare payment rate for a State giving coverage to everyone in the expansion group equivalent to minimum essential coverage, and at 110 percent of that rate for any other State. Where no published Medicare rate exists, the State plan rate is used.
What the document actually says
“the total payment rate for such service is limited to--”
That sentence, in plain words
The total rate for a service is capped. The two figures that follow set it.
What this is about
A state that expanded Medicaid is held to the Medicare rate. Any other state may go to 110 percent of it. If there is no Medicare rate, the state plan rate is used.
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Provide for reconciliation pursuant to title II of H. Con. Res. 14, Public Law 119-21, sec. 71116, 139 Stat. 303 (2025). https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm
This page
“The cap is the Medicare rate, or 110 percent of it in other states,” Provide for reconciliation pursuant to title II of H. Con. Res. 14, section 71116, Sec. 71116. Read the Mandate, https://readthemandate.org/pl-119-21/proposal/sec71116-caps/ (retrieved August 26, 2026).
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