Legislative memo — Medicaid Integrity, Access, and Accountability Act of 2025

To Policy Staff, Stakeholders, Legislative Counsel
From Floyd Taylor, Candidate for Congress (IN‑9)
Re Medicaid Reform Proposal — Bipartisan Framework
Date [Insert Date]

Purpose: Modernize Medicaid to satisfy fiscal conservatives’ demands for integrity and efficiency while advancing progressives’ goals for access and equity — with measurable outcomes, transparent reporting, and budget discipline.

🔍 Eligibility integrity (SSA §1902(e))

  • Real‑time verification at application/renewal using wage, death, and benefits databases.
  • Monthly cross‑checks; immutable audit logs of determinations.
  • Public monthly reporting: redeterminations, terminations, error rates.

💼 Work & skills supports (SSA §1115 authority)

  • “Engage or exempt” model: job search/training, education, or recovery supports.
  • Automatic exemptions: medical frailty, caregiving, pregnancy/postpartum (12 months), students.
  • Good‑cause protections; federal match for transport/childcare supports.

🏥 Primary care and value‑based payments (SSA §1902(a))

  • Primary care floor at 100% of Medicare Part B rates; bonus for timely access.
  • Reimburse integrated care teams: CHWs, behavioral health in primary care.
  • Shared‑savings contracts tied to quality metrics and ER diversion.

💊 Pharmacy & PBM reform (SSA §1927)

  • Ban spread pricing; mandate full pass‑through of rebates/discounts.
  • State audit rights over PBM contracts, networks, and claims.
  • 48‑hour approval or deem‑approved for generics/biosimilars when clinically appropriate.

🌾 Rural access & telehealth

  • Global budgets for rural hospitals/clinics tied to access and quality.
  • Telehealth parity (including audio‑only where appropriate) for primary, behavioral, specialty.
  • Mobile clinic grants for dental, vision, and primary care.

🧠 Behavioral health integration

  • Same‑day billing permitted for primary + behavioral at same site.
  • Coverage for mobile crisis, stabilization, MAT, IOP, and peer support.
  • No arbitrary visit caps; medical necessity governs.

📊 Transparency & public dashboards

  • Monthly public KPIs: enrollment, wait times, ER use, maternal/behavioral outcomes, PMPM spend.
  • Publish managed care and PBM contracts, rate methods, guarantees, penalties.
  • Public complaint tracker with timestamps and resolution SLAs.

💡 Evaluation, sunset, and reinvestment

  • Independent evaluation at 5 years on integrity, access, outcomes, and spend.
  • Sunset unless benchmarks met or exceeded; continuation tied to results.
  • ≥ 50% of verified savings reinvested in primary care, workforce, rural access.

Implementation path

  • 0–90 days Draft 1115 waiver; stakeholder sessions with providers, beneficiaries, employers, counties.
  • 90–180 days Submit to CMS; build dashboards; finalize PBM pass‑through contracts.
  • Year 1 Launch pilots in one rural and one urban region; independent baseline study.
  • Years 2–3 Scale statewide if access, quality, and budget targets are met.

Budget impact

  • Expected savings from integrity measures, ER diversion, and PBM reforms.
  • Budget neutrality for waivers; transparent annual reporting to Congress and states.
  • Mandatory reinvestment of savings into primary care capacity, workforce supports, rural access.
Call to action: Align counsel and agencies on statutory amendments and waiver language; prepare data-sharing MOUs; stand up public dashboards to demonstrate quick wins on integrity and access.