Vote Smart's Synopsis:

Vote to pass a bill that expands Medicaid eligibility.

Highlights:

• Requires the Department of Health and Human Services to submit a request to the secretary of the U.S. Department of Health and Human Services for a waiver that provides health insurance coverage through private insurance options for “eligible individuals” with a low risk of needing extensive medical services and who meet one of the following conditions (Sec. 10):
• They are currently employed or actively seeking employment;
• They are primary caregivers for a family member; or
• They are the spouse of an adult who is employed or actively seeking employment.

• Defines “eligible individual” as an individual who is under 65 years of age, not pregnant, and who has an income that does not exceed 133% of the federal poverty level (Sec. 9).

• Requires the department redesign the Medicaid program to meet certain measures including, but not limited to, the following measures (Sec. 15):
• Implementing a patient-centered medical home model of care;
• Amending access restrictions to emergency departments;
• Requiring medical service providers to see Medicaid patients within a specified time frame; and
• Providing targeted patient education.

• Requires Medicaid service providers and health insurance issuers to pay the department insurance assistance mitigation fees in an amount proportionate to each provider’s or issuer’s services (Secs. 13 & 17).

• Requires the department to collect the following amounts from insurance assistance mitigation fees per fiscal year (Secs. 13 & 17):
• $20 million from Medicaid service provider fees; and
• $10 million form health insurance issuer fees.

• Establishes a value-based purchasing system with incentive payments for hospitals, physicians, nurses, long-term care facilities, and home health care agencies that meet established performance standards (Sec. 16).

Full Bill Text