Statement for the Congressional Record by Senator Chuck Grassley of Iowa
“Common Sense Program Integrity Measures for Medicaid”
Wednesday, July 2, 2025
 

Contrary to misinformation campaigns seeking to stop common-sense Medicaid reforms from getting to the President’s desk, the One Big Beautiful Bill does not take away Medicaid from those who need it. 

In fact, the bill will strengthen the Medicaid program, so that it can continue to serve the vulnerable populations it was designed to serve. 

Before I discuss the program integrity measures in this bill, I want to give some context on Medicaid spending. 

Under this bill, Medicaid will spend over $7.4 trillion over 10 years. 

We’re only slowing the growth of Medicaid spending, as Medicaid spending will still go up at about two to three percent annually compared to 4.5 to five percent annually if we don’t pass this bill. 

A sizable majority of Americans support efforts to stop wasteful spending that drains resources for people who truly need this safety net and puts an unfair burden on taxpayers. 

Between 2015 and 2024, the total amount of improper federal Medicaid payments was over $560 billion

Some independent estimates put it closer to $1.1 trillion. We must do something about it. 

I’m also the author of major updates to the False Claims Act, a major tool to save taxpayers money. 

Since my reforms were enacted, the federal government has recovered more than $78 billion lost to fraud – much of it in government health care programs – and saved billions more by deterring would-be fraudsters.

We’re doing more in this bill, because taxpayers and those who rely on Medicaid deserve better. 

That’s why we are putting an end to the billions of dollars of waste, fraud and abuse in health care programs.  

Let me list off a few provisions that establish some program integrity:
  • Reducing duplicate enrollment under the Medicaid program.
  • Ensuring deceased individuals and health care providers don’t remain enrolled.
  • Payment reduction for erroneous excess provider payments under Medicaid.
  • We’re also going to require states to check if an individual is eligible to be on Medicaid twice a year, instead of once a year.

These provisions alone save over $94 billion, according to the non-partisan Congressional Budget Office (CBO).

We establish robust verification for individuals receiving premium tax credits through the federal marketplace. 

We also ensure that, if someone gets more subsidization than they’re allowed based on their income, the excessive subsidy amount is returned. 

Last year, I pointed out to the Treasury Inspector General that excessive payments were not being recouped. 

Through my oversight, I discovered over 40 percent of excessive federal marketplace subsidy payments totaled over $10 billion dating back to 2016. 

These excess payments were not recouped because of current safe harbor rules. 

This excessive waste will end in this bill and save over $60 billion, according to CBO.

We also delay costly regulations that establish one-size-fits-all rules including for nursing homes and state Medicaid programs. 

I’m a strong proponent of nursing home oversight and ensuring our most vulnerable senior citizens and those with disabilities have access to high-quality care.

We should be addressing the workforce challenges nursing homes face by partnering with nursing homes, not mandating from Washington, DC.

Delaying the nursing home staffing mandate rule and so-called “streamlining eligibility rule” saves over $187 billion, according to CBO.

We also ensure Medicaid, Medicare and federal marketplace resources are going to Americans, instead of illegal aliens. 

Taxpayers expect us to prioritize vulnerable Americans and seniors in these programs.

We prohibit federal financial support under Medicaid for individuals who don’t have verified citizenship, nationality or satisfactory immigration status. 

These provisions save over $163 billion according to CBO.

When my colleagues on the other side of the aisle fearmonger and misinform what’s in the bill, they must be willing to defend billions in health care waste, fraud and abuse spending that total over $500 billion, as standalone provisions.

As I’ve illustrated, we establish commonsense program integrity measures and stop wasteful spending. 

We delay costly regulations that hurt patients and providers, especially those living in rural America.

We stop Medicaid and Medicare resources from going to illegal aliens. 

Most importantly, we preserve the Medicaid program for those who most need it.

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