This part tightens the cap on state taxes on health providers. In expansion states the cap falls from 5.5 percent in 2028 to 3.5 percent by 2032. A state with no such tax now is held at zero. Territories are not covered.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71115 in the PDF
What the document says
“and for fiscal years beginning on or after October 1, 2026, the applicable percent determined under subparagraph (D) shall be substituted for `6 percent' each place it appears”
The section amends section 1903(w)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1396b(w)(4)) so that from fiscal years beginning on or after October 1, 2026 a new applicable percent replaces the fixed 6 percent wherever it appears.
What the document actually says
“and for fiscal years beginning on or after October 1, 2026, the applicable percent determined under subparagraph (D) shall be substituted for `6 percent' each place it appears”
That sentence, in plain words
A new figure takes over from October 1, 2026. It stands in for 6 percent. That holds wherever those words appear.
What this is about
The new figure is worked out under a new rule. That rule differs by kind of state. The older law it sits in is not indexed here.
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.
The document says “means”Who acts: Congress, Secretary of Health and Human ServicesHow: statuteSec. 71115 in the PDF
What the document says
“in the case of a non-expansion State or unit of local government in such State and a class of health care items or services described in section 433.56(a) of title 42, Code of Federal Regulations”
The section adds a new subparagraph (D) to section 1903(w)(4) of the Social Security Act. For a non-expansion State the applicable percent is the percent of net patient revenue already found to be within the hold harmless threshold at enactment where such a tax exists, and zero where none does. For an expansion State it is the lower of that already determined percent and the declining schedule, and zero where no such tax exists. An expansion State is one that from January 1, 2014 or later chose to cover everyone described in section 1902(a)(10)(A)(i)(VIII).
What the document actually says
“in the case of a non-expansion State or unit of local government in such State and a class of health care items or services described in section 433.56(a) of title 42, Code of Federal Regulations”
That sentence, in plain words
One rule covers a state that did not expand Medicaid. It turns on a class of care named in the rules.
What this is about
A state already taxing that class keeps its current figure. A state with no such tax is held at zero. Expansion states are treated apart.
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.
The section sets the ceiling for an expansion State at 5.5 percent for fiscal year 2028, 5 percent for 2029, 4.5 percent for 2030, 4 percent for 2031, and 3.5 percent for fiscal year 2032 and each year after. A tax already in effect at enactment on a class described in paragraph (3) or (4) of the regulation, and within the hold harmless threshold, keeps its own determined percent instead.
What the document actually says
“for fiscal year 2028, 5.5 percent;”
That sentence, in plain words
For fiscal year 2028 the figure is 5.5 percent.
What this is about
It drops half a point each year after. By fiscal year 2032 it reaches 3.5 percent. It stays there from then on.
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.
The document says “shall apply”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71115 in the PDF
What the document says
“The amendments made by this section shall only apply with respect to a State that is 1 of the 50 States or the District of Columbia.”
The section applies its amendments only to the 50 States and the District of Columbia, and appropriates $20,000,000 for fiscal year 2026 to the Administrator of the Centers for Medicare & Medicaid Services, to remain available until expended.
What the document actually says
“The amendments made by this section shall only apply with respect to a State that is 1 of the 50 States or the District of Columbia.”
That sentence, in plain words
The changes reach only the 50 states. They reach the capital too. No other place is covered.
What this is about
Territories are left out. The agency also gets $20 million for fiscal year 2026. The money stays there until it is spent.
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: substitute a new applicable percent for the fixed 6 percent from fiscal year 2027, set that percent for expansion and non-expansion States, set the declining schedule, define an expansion State and a non-expansion State, carve out certain existing expansion State taxes, exclude territories, and appropriate implementation funding.
The detailed interaction between the two subclauses of clause (i), which is carried in a summary.
The section works by amending section 1903(w)(4) of the Social Security Act and points to section 433.56(a) of title 42 of the Code of Federal Regulations, neither of which is indexed here.
