This part shortens how far back Medicaid cover can reach. For the expansion group it is one month before the claim. For everyone else it is two months. It reaches claims made from the first quarter after 2026.
“such assistance will be made available to the individual for care and services included under the plan and furnished in or after the month before the month in which the individual made application”
The section rewrites section 1902(a)(34) of the Social Security Act (42 U.S.C. 1396a(a)(34)) so that for a person enrolled under the expansion group in paragraph (10)(A)(i)(VIII) cover reaches care given in or after the month before the month of application, and for everyone else in or after the second month before that month, in each case where the person was or would have been eligible when the care was given. A deceased person's application may be made on their behalf.
What the document actually says
“such assistance will be made available to the individual for care and services included under the plan and furnished in or after the month before the month in which the individual made application”
That sentence, in plain words
Cover reaches care given from the month before. That is the month before the claim went in.
What this is about
That shorter reach is for the expansion group. Everyone else gets two months. The person must have qualified when the care was given.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by striking "in or after the third month before the month in which the recipient makes application for assistance"”
The section strikes the words setting a three month lookback in section 1905(a) of the Social Security Act and inserts words giving one month for a person described in section 1902(a)(34)(A) and two months for a person described in section 1902(a)(34)(B).
What the document actually says
“Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by striking "in or after the third month before the month in which the recipient makes application for assistance"”
That sentence, in plain words
Old wording is taken out of a health law. It set a three month reach back.
What this is about
New wording puts one month for one group. It puts two months for the other. That matches the rule above.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“provide that such assistance is not made available to such individual for items and services included under the State child health plan (or waiver of such plan) that are furnished before the second month preceding the month in which such individual made application”
The section adds a new clause (vi) to section 2102(b)(1)(B) of the Social Security Act so that where a State chooses to give child health or pregnancy-related assistance for a period before the month of application, it may not cover items and services given before the second month preceding that month. The changes apply to applications made on or after the first day of the first quarter beginning after December 31, 2026, and $10,000,000 is appropriated for fiscal year 2026 to the Administrator of the Centers for Medicare & Medicaid Services, to remain available until expended.
What the document actually says
“provide that such assistance is not made available to such individual for items and services included under the State child health plan (or waiver of such plan) that are furnished before the second month preceding the month in which such individual made application”
That sentence, in plain words
Cover may not reach care given too early. The cut-off is two months before the claim.
What this is about
A state may still choose to reach back at all. This only caps how far. The change reaches claims made from 2027.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: set the two lookback periods, match the definition of medical assistance to them, bar earlier cover in the children's health program, fix the effective date, and appropriate implementation funding.
The punctuation edits that make room for the new clause in the children's health provision.
The section works by amending sections 1902(a)(34), 1905(a) and 2102(b)(1)(B) of the Social Security Act, none of which is indexed here, so how cover otherwise works cannot be checked against anything on this site.
