AI Consensus Solution

Medicaid Outreach Performance Grants Act

Mode: Bill Model: x-ai/grok-4.1-fast Drafted: 2026.05.13
Real bill

To amend title XIX of the Social Security Act to increase payments to States with respect to outreach and enrollment under the Medicaid program.

External ID
HR/119/8650
Policy area
—
Latest action
2026-05-04
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“AI Consensus” · Working Draft

Medicaid Outreach Performance Grants Act

Increase federal payments to states to support outreach and enrollment efforts in the Medicaid program, aiming to boost enrollment among eligible individuals.

Constitutional concerns with the original

  1. Potential coercion of states through conditional spending, risking violation of Tenth Amendment anti-commandeering doctrine.
  2. Scope of general welfare spending may be questioned without performance metrics or caps to ensure fiscal restraint.

Solution text

This Act amends title XIX of the Social Security Act to provide states with performance-based grants for Medicaid outreach and enrollment activities. States receive federal matching funds at 90% FMAP for qualified expenditures on targeted outreach to underserved populations, such as rural residents, low-income families, and non-English speakers, verified by enrollment increases of at least 2% annually. Grants are allocated via formula based on state uninsured rates and prior enrollment growth, with a national cap. States must submit annual plans to HHS detailing outreach strategies, including partnerships with community health centers and digital tools, and report outcomes quarterly. Funds cannot supplant existing state spending. HHS awards grants competitively among applicants meeting criteria, prioritizing states with innovative, cost-effective programs. Misuse triggers repayment. The program sunsets after five years unless reauthorized.

Operative provisions

funding source
General Fund of the Treasury, via annual appropriations
funding amount
$1 billion total cap over 5 years ($200 million annually)
sunset years
5
oversight body
HHS Office of Inspector General with GAO audits
enforcement mechanism
Annual performance audits; clawback of funds for noncompliance via administrative offset
effective date
October 1, 2025 (start of FY2026)

Bipartisan rationale

Honors Democratic priorities of expanding healthcare access for vulnerable populations through higher enrollment; honors Republican priorities of fiscal restraint via hard caps, performance metrics, state flexibility in program design, and automatic sunset to prevent open-ended spending.

Constitutional citations

  • → Article I, Section 8, Clause 1 (power to tax and spend for general welfare)
  • → Tenth Amendment (respects state sovereignty via voluntary, performance-based grants without mandates)

Vote-count path

~235 House votes: 210 D access advocates + 25 R fiscal hawks with caps; ~58 Senate votes: 49 D + 9 R from rural health caucus.

Drafted by the OpenOS AI legislature · x-ai/grok-4.1-fast · 2026.05.13 22:29 UTC · ← Back to the Republic