Requiring Budget Neutrality for Medicaid Demonstration Projects under Section 1115
Section 71118 · Sec. 71118 ·
What this chapter is about
This part requires Medicaid demonstration projects to be budget neutral. From January 1, 2027 the chief actuary must certify no rise in federal spending. Savings in one period are carried into the next. The agency gets $5 million a year.
The document says “may not”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71118 in the PDF
What the document says
“the Secretary may not approve an application for (or renewal or amendment of) an experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of title XIX in a State”
The section adds a new subsection (g) to section 1115 of the Social Security Act (42 U.S.C. 1315) barring the Secretary, from January 1, 2027, from approving an application, renewal or amendment for a Medicaid demonstration project unless the Chief Actuary for the Centers for Medicare & Medicaid Services certifies that it is not expected to raise federal spending above what it would otherwise be. Spending for people and services the State could have covered under its plan or other authority counts as spending in the absence of the project, including where the service would be given at a different site.
What the document actually says
“the Secretary may not approve an application for (or renewal or amendment of) an experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of title XIX in a State”
That sentence, in plain words
The Secretary may not approve such a project. That covers a new one, a renewal and a change.
What this is about
From January 1, 2027 a certificate is needed first. The chief actuary must give it. It must say federal spending will not rise.
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”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71118 in the PDF
What the document says
“the Secretary shall specify the methodology to be used with respect to the subsequent approval period for such project for purposes of taking the difference between such expenditures into account.”
The section requires the Secretary, where spending under a project in an approval period comes in below what it would have been without the project, to set the method used in the next approval period for taking that difference into account. It also appropriates $5,000,000 for each of the named fiscal years to the Administrator of the Centers for Medicare & Medicaid Services.
What the document actually says
“the Secretary shall specify the methodology to be used with respect to the subsequent approval period for such project for purposes of taking the difference between such expenditures into account.”
That sentence, in plain words
The Secretary must set a method. It covers the next approval period. It takes the gap in spending into account.
What this is about
The gap arises when a project spends less than planned. The saving is not simply kept. It is carried into the next round.
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: bar approval without an actuary certification, fix what counts as spending in the absence of the project, require a method for treating savings, and appropriate implementation funding.
Nothing in the section is left out. It has two subsections and each is recorded.
The section works by adding a subsection to section 1115 of the Social Security Act, which is not indexed here, so how demonstration projects otherwise work cannot be checked against anything on this site.
