HB 3399 amends title XIX of the Social Security Act to require Medicaid state plans to treat active-duty relocated individuals as residents of the military service relocation state for purposes of eligibility, beginning January 1, 2028, unless the individual elects not to be treated as such. If an active-duty relocated individual is on a home and community-based services waiting list at relocation, they remain on the list until the state completes an assessment and renders a decision on eligibility or until the individual elects to be removed.
The bill also authorizes payment for medical assistance on behalf of the relocated individual in the relocation state to the extent such assistance is available, and it provides implementation funding and a potential delayed effective date if a state requires legislation other than funding.
At a Glance
What It Does
The bill amends the Medicaid state plan to treat active-duty relocated individuals as residents of the military service relocation state for eligibility purposes starting in 2028. It also governs HCBS waiting lists for these individuals and sets a funding- and state-implementation framework.
Who It Affects
Medicaid programs in the military service relocation state and the home state, active-duty service members and their dependents, and providers of home- and community-based services.
Why It Matters
Creates a uniform residency rule for military relocations, reduces cross-state eligibility ambiguity, and clarifies financing for relocated individuals’ Medicaid services.
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What This Bill Actually Does
The Care for Military Kids Act amends federal Medicaid rules to change how residency is determined for military families who move because of active-duty relocations. Starting in 2028, an active-duty relocated individual will be treated as a resident of the relocation state for the purposes of Medicaid eligibility, unless they opt out.
If they are on a state HCBS waiting list at the time of relocation, they stay on that list until the state completes an assessment and decides eligibility or until they choose to be removed. The bill also provides that Medicaid payments for these individuals can be made by the relocation state to the extent such payments are available, and it allocates funding to implement the changes.
Two related mechanisms are defined: who counts as an active-duty relocated individual and what constitutes a home and community-based services waiting list. The act includes an implementation funding line and a provision for a delayed effective date if a state needs legislation beyond funding to comply.
The Five Things You Need to Know
The bill requires that starting 1 January 2028, active-duty relocated individuals be treated as residents of the relocation state for Medicaid eligibility.
If on an HCBS waiting list at relocation, individuals remain on the list until assessment/eligibility decision or removal.
Medicaid payments for relocated individuals can be made by the relocation state to the extent available.
Defines active-duty relocated individual and the HCBS waiting list, including dependents and recent active-duty status.
Provides $1,000,000 annually (FY 2026–2030) for implementation and allows a state delay if non-funding legislation is required.
Section-by-Section Breakdown
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Residency determination for active-duty relocated individuals
This provision requires added language to Section 1902(a) to treat an active-duty relocated individual as a resident of the military service relocation state for Medicaid eligibility purposes, effective January 1, 2028, unless the individual elects not to be treated as such. It also ties eligibility for medical assistance to the relocation-state residency status and makes related adjustments to coverage when a home and community-based services (HCBS) balance or waiting list is involved.
Definitions: active-duty relocated individual and HCBS waiting list
Defines who qualifies as an active-duty relocated individual, including service members and dependents who relocate due to active-duty service and meet timing criteria (last active duty day within 12 months, or related conditions). It also defines the HCBS waiting list and anchors the waiting list concept to the applicable state authorities and service definitions used in current HCBS programs.
Implementation funding
Allocates $1,000,000 for each fiscal year 2026 through 2030 to the Secretary of Health and Human Services to implement the amendments. This funding remains available until expended and is dedicated to enabling state plan changes, inter-state coordination, and related administrative modifications.
Effective date and potential delay
General rule: the amendments take effect on the date of enactment. If a state plan approved under title XIX requires non-funding legislation to meet the new requirements, the plan can delay full compliance until the first calendar quarter after the end of the first regular session of the state legislature that ends after the enactment, with session-length provisions clarifying how a state with a longer session is treated.
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Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Active-duty relocated service members and their dependents gain clearer eligibility rules and potentially faster access to Medicaid services in the relocation state.
- Medicaid programs in the military service relocation state gain a uniform framework for residency determinations that reduces inter-state ambiguity.
- Home and community-based services (HCBS) providers in relocation states may experience more predictable enrollment and service delivery pathways.
- Federal program administrators (HHS) gain clearer, standardized guidelines for cross-state Medicaid coverage in military relocations.
Who Bears the Cost
- State Medicaid agencies in the relocation state incur administrative changes and potential higher ongoing costs associated with new residency determinations and cross-state eligibility processing.
- States operating HCBS waiting lists may face administrative burden to align with new rules and ensure timely assessments.
- The federal government bears implementation oversight costs and potential budgetary shifts during transition.
Key Issues
The Core Tension
Balancing uniform eligibility rules for military families across states with the practical realities of state HCBS waiting lists, administrative capacity, and funding constraints.
The bill creates a notable policy shift by assigning residency for Medicaid eligibility to the relocation state for a defined class of military families. This shifts some cost and administrative responsibilities to states that host relocated individuals, even as those states may already be managing HCBS waiting lists and competing eligibility demands.
The funding line helps, but it is limited and does not guarantee a long-term funding solution; the delayed effective date mechanism introduces state-level timing risk if state legislatures cannot align quickly. The interplay between opt-out rules, waiting-list mechanics, and the definition of an active-duty relocated individual could produce implementation edge cases, such as determining when a dependent qualifies or how to handle mixed eligibility across programs.
The law also relies on state legislation (beyond funding) for some states to achieve full compliance, creating potential unevenness in adoption timelines across jurisdictions.
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