Bill Overview
Title: Medicaid Third Party Liability Act
Description: This bill modifies requirements relating to Medicaid third-party liability. Current law generally requires legally liable third parties (e.g., health insurers) to pay claims before Medicaid. However, Medicaid must pay first (and seek reimbursement from liable third parties) for claims for (1) preventive pediatric care, and (2) services for an individual for whom child support enforcement is being conducted by the state. The bill repeals these exceptions. Current law also requires state Medicaid programs to take all reasonable measures to identify legally liable third parties. The bill specifically prohibits federal Medicaid payment for services to individuals for whom third-party insurance information was not obtained and verified by the state.
Sponsors: Rep. Burgess, Michael C. [R-TX-26]
Target Audience
Population: Individuals enrolled in Medicaid
Estimated Size: 75000000
- The Medicaid program currently serves approximately 75 million people in the United States, providing health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities.
- Children who receive preventive care and individuals who receive child support services are directly impacted by this bill, as it changes reimbursement processes for these groups specifically.
- Health insurers and other third parties who may have legal responsibilities for healthcare costs will also be impacted, as the bill modifies when they are required to pay versus when Medicaid pays first.
- The bill affects all states as it changes federal requirements for Medicaid programs to identify third-party liability.
Reasoning
- The Medicaid program impacts approximately 75 million people from various demographic groups, which means the policy must consider a wide range of conditions and circumstances.
- The policy's impact will be significant on those families whose children receive preventive care and those involved in child support enforcement.
- The financial burden on families who rely on Medicaid for these specific services could increase due to changes in third-party liability processes.
- Costs associated with implementation include potential delays or denied services due to the need for verification of third-party insurance coverage.
- The policy redirects financial responsibilities from Medicaid to other insurers, potentially impacting the service delivery and payment processes for approximately 5-10 million Medicaid beneficiaries in the target groups.
- Individuals are included to represent a spectrum from high, medium, low, and no impact scenarios to reflect variability across Medicaid enrollees.
Simulated Interviews
unemployed (Florida)
Age: 29 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 12/20
Statement of Opinion:
- I am worried about delays in getting medical services for my child. With this policy, we might need to wait longer for insurers to settle payments before getting the healthcare we need.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 5 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 7 |
| Year 10 | 6 | 7 |
| Year 20 | 6 | 7 |
software engineer (California)
Age: 34 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- I am not directly affected by Medicaid policies, but I am concerned about the overall healthcare system and its efficiency.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
retired (New York)
Age: 62 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- With Medicaid changes, I'm concerned about the direct impact on the healthcare accessibility for my grandchildren, who need preventive care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 8 |
truck driver (Texas)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 8/20
Statement of Opinion:
- The policy might mess up our already tight schedule with more paperwork or delays in payment processes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 7 |
| Year 10 | 6 | 7 |
| Year 20 | 6 | 7 |
nurse (Illinois)
Age: 38 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 9/20
Statement of Opinion:
- I'm really nervous about what these changes could mean for my children getting the preventive care they need on time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 7 |
| Year 2 | 6 | 7 |
| Year 3 | 7 | 8 |
| Year 5 | 7 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 6 | 8 |
student (Ohio)
Age: 23 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- These changes seem to add more confusion to an already confusing system, and I'm concerned about how it will affect getting care for my child.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 5 |
| Year 2 | 4 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 6 |
| Year 10 | 5 | 6 |
| Year 20 | 5 | 6 |
construction worker (Georgia)
Age: 57 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 13/20
Statement of Opinion:
- I don't think this policy affects me much directly, but it's frustrating whenever changes are made.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
part-time retail worker (Nevada)
Age: 46 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 11/20
Statement of Opinion:
- I'm worried this will slow down services and make what's already challenging even harder.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 5 |
| Year 2 | 5 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 5 | 6 |
| Year 20 | 5 | 6 |
disabled, former mechanic (Michigan)
Age: 55 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 14/20
Statement of Opinion:
- From what I see, this policy doesn't change things much for my situation since I'm not involved with the groups it targets.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
teaching assistant (New Mexico)
Age: 31 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- While I understand the need for tight procedures, the policy seems to complicate things, especially when insurance and Medicaid are both involved.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 8 |
Cost Estimates
Year 1: $150000000 (Low: $100000000, High: $200000000)
Year 2: $160000000 (Low: $110000000, High: $210000000)
Year 3: $170000000 (Low: $120000000, High: $220000000)
Year 5: $180000000 (Low: $130000000, High: $230000000)
Year 10: $200000000 (Low: $140000000, High: $250000000)
Year 100: $300000000 (Low: $150000000, High: $350000000)
Key Considerations
- Impact on low-income individuals who depend on Medicaid and might face delayed service due to verification processes.
- Increased administrative burden for states in tracking and verifying third-party liabilities.
- Changes in how Medicaid claims are processed might require new systems or modifications to existing ones, involving technology and operational adjustments.