MediKids

(a)

Eligibility until age 26

(1)

In general

Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended—(A)by striking or at the end of subclause (VIII);(B)in subclause (IX)(dd), by inserting or at the end; and(C)by adding at the end the following new subclause:

(X)beginning on the date that is 2 years after the date of enactment of this subclause, who are individuals who have not attained 26 years of age;

(2)

Effective date

The amendment made by this subsection shall take effect on the date of enactment of this Act.(b)

Automatic enrollment

Section 1902(e) of the Social Security Act is amended by striking paragraph (4) and inserting the following:

(4)

Automatic enrollment of children

(A)

In general

Any child born in a State on or after the date that is 2 years after the date of enactment of the MediKids Act shall be considered to have applied for medical assistance under the State plan and shall be automatically enrolled for such assistance on the date of their birth.(B)

Notification requirement

The State shall inform the parent, guardian, or custodial relative of a child who is automatically enrolled in the State plan under subparagraph (A) of the services that will be covered, appropriate methods for using such services, medical support obligations (under section 1912(a)) created by enrollment (if applicable), the actions the parent, guardian, or relative must take (if any) to maintain enrollment, and the actions the parent, guardian, or relative may take to disenroll the child.(C)

Opt-out if other coverage is available

The State shall establish a process to allow the parent, guardian, or custodial relative of a child who is automatically enrolled in the State plan under subparagraph (A) to disenroll the child from the State plan through affirmation in writing if the child is enrolled in other health benefits coverage that—(i)at a minimum, provides the essential health benefits defined by the Secretary under section 1302(b) of the Patient Protection and Affordable Care Act; and(ii)meets such other requirements as the Secretary determines appropriate.(D)

Special rule

With respect to an individual who is automatically enrolled in the State plan under subparagraph (A) as a child and has attained 18 years of age, the notification requirement described in subparagraph (B) and the opt-out requirement described in subparagraph (C) shall apply to such individual in lieu of the parent, guardian, or custodial relative of such individual.

(c)

Continuous eligibility

Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended—(1)in the heading by inserting

and young adults

after

children

;(2)in the matter preceding subparagraph (A), by striking 19 and inserting 26;(3)by striking subparagraph (A);(4)by redesignating subparagraphs (B) and (C) as subparagraphs (A) and (B); and(5)in subparagraph (A), as so redesignated, by striking 19 and inserting 26.(d)

Exclusion from definition of minimum essential coverage

Section 36B(c)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:

(D)

Treatment of certain coverage under the Medicaid program

For purposes of subparagraph (B), an individual shall not be treated as eligible for minimum essential coverage if—(i)such coverage consists of eligibility for medical assistance under a State Medicaid program under section 1902(a)(10)(A)(i)(X) of the Social Security Act; and(ii)the individual is not enrolled in such a program for such medical assistance.

(e)

Coverage of children and young adults without regard to immigration status

(1)

In general

Section 1903(v) of the Social Security Act (42 U.S.C. 1396b(v)) is amended—(A)in paragraph (1), by striking and (5) and inserting (5), and (6);(B)in paragraph (4)(A)(ii)—(i)in the clause header, by inserting

and young adults

after

Children

; and(ii)by striking 21 and inserting 26; and(C)by adding at the end the following paragraph:

(6)(A)Notwithstanding any other provision of law, on and after the date that is 2 years after the date of enactment of this paragraph, a State shall provide medical assistance under this title to any individual residing or present in the United States who is eligible for medical assistance under section 1902(a)(10)(A)(i)(X), without regard to whether the individual is lawfully residing or lawfully present in the United States.(B) No debt shall accrue under an affidavit of support against any sponsor of an individual provided medical assistance in accordance with subparagraph (A) and the cost of such assistance shall not be considered as an unreimbursed cost.

(2)

Conforming amendments

(A)Section 1137(f) of the Social Security Act (42 U.S.C. 1320b–7(f)) is amended by inserting or to individuals who are eligible for medical assistance under section 1902(a)(10)(A)(i)(X) and are provided such assistance in accordance with section 1903(v)(6) before the period.(B)Section 2107(e)(1)(Q) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(Q)) is amended by inserting and young adults after children each place it appears.(C)Section 402(b)(2) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end the following:

(H)

Medicaid exception for children and young adults

With respect to eligibility for benefits for the program defined in paragraph (3)(C) (relating to the Medicaid program), section 401(a) and paragraph (1) shall not apply to any individual who has not attained 26 years of age.

(D)Section 403(d) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613(d)) is amended—(i)by striking or at the end of paragraph (1);(ii)by striking the period at the end of paragraph (2) and inserting ; or; and(iii)by adding at the end the following:

(3)an individual described in section 402(b)(2)(H), but only with respect to the program specified in subsection (b)(3)(C) of section 402.

(E)Section 431(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is amended—(i)by striking or at the end of paragraph (7);(ii)by striking the period at the end of paragraph (8) and inserting , or; and(iii)by adding at the end the following:

(9)an individual who has not attained 26 years of age, but only with respect to the designated Federal program defined in section 402(b)(3)(C) (relating to the Medicaid program).

(3)

Effective date

The amendments made by this subsection shall take effect on the date of enactment of this Act.(f)

100 percent Federal matching payments for medical assistance for children and young adults

(1)

In general

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—(A)in subsection (b), by striking and (ii) and inserting (ii), and (ll); and(B)by adding at the end the following new subsection:

(ll)

Enhanced FMAP for certain children and young adults

Notwithstanding subsection (b), beginning on the date that is 2 years after the date of enactment of this subsection, the Federal medical assistance percentage shall be 100 percent with respect to amounts expended by a State for medical assistance for individuals—(1)who are eligible for medical assistance under section 1902(a)(10)(A)(i)(X); and(2)who would not have been eligible for medical assistance for full benefits (as defined in subsection (y)(2)(B)) under the State plan under this title or a waiver of such plan as such plan or waiver was in effect on January 1, 2025.

(2)

Effective date

The amendment made by this subsection shall take effect on the date of enactment of this Act.(g)

Exclusion from community engagement requirement

(1)

Mandatory exception for certain individuals

Section 1902(xx)(3)(A)(i)(II) of the Social Security Act (42 U.S.C. 1396a(xx)(3)(A)(i)(II)) is amended—(A)in item (aa), by striking 19 and inserting 26; and(B)in item (cc), by inserting or (X) after (VII).(2)

Specified excluded individuals

(A)

In general

Section 1902(xx)(9)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1396a(xx)(9)(A)(ii)(I)) is amended to read as follows:

(I)who is described in subclause (IX) or (X) of subsection (a)(10)(A)(i);

(B)

Conforming amendment

Section 1902(xx)(9)(A)(i)(II)(bb) of the Social Security Act (42 U.S.C. 1396a(xx)(9)(A)(i)(II)(bb)) is amended by striking 19 and inserting 26.(h)

Expansion of EPSDT

(1)

In general

Section 1905(a)(4)(B) of the Social Security Act (42 U.S.C. 1396d(a)(4)(B)) is amended by striking 21 and inserting 26.(2)

Conforming amendment

Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended in section 1902(a)(43)(A), by striking 21 and inserting 26.(i)

Other conforming amendments

Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—(1)in section 1905(a)—(A)in the matter preceding paragraph (1)—(i)in clause (i), by striking 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose and inserting 26; and(ii)in clause (xiv), by striking or 1902(a)(10)(A)(i)(IX) and inserting , 1902(a)(10)(A)(i)(IX), or 1902(a)(10)(A)(i)(X); and(B)in paragraph (16)(A), by striking 21 and inserting 26;(2)in section 1905(h)(1)—(A)in the matter preceding subparagraph (A), by striking 21 and inserting 26; and(B)in subparagraph (C)—(i)by striking 21 each place it appears and inserting 26; and(ii)by striking 22 and inserting 27;(3)in section 1915(l)(7)(A)(ii), by striking 21 and inserting 26;(4)in section 1916—(A)in subsection (a)(2)(A), by striking 18 years of age (and, at the option of the State, individuals under 21, 20, or 19 years of age, or any reasonable category of individuals 18 years of age or over) and inserting 26 years of age; and(B)in subsection (b)(2)(A), by striking 18 years of age (and, at the option of the State, individuals under 21, 20, or 19 years of age, or any reasonable category of individuals 18 years of age or over) and inserting 26 years of age;(5)in section 1917—(A)in subsection (a)(2)(B), by striking 21 and inserting 26; and(B)in subsection (b)(2)(A), by striking 21 and inserting 26; and(6)in section 1937(a)(2)(B), by adding at the end the following new clause:

(xii)

MediKids

The individual qualifies for medical assistance on the basis of section 1902(a)(10)(A)(i)(X).

(j)

Effective date

Except as otherwise provided, the amendments made by this section shall take effect on the date that is 2 years after the date of enactment of this Act.