This bill prohibits the Department of Health and Human Services from using funds made available by prior Appropriations Acts in the current fiscal year for any activity that would “deem” a Medicare enrollee who fails to make an election under section 1851(e)(1) to have elected a Medicare Advantage (MA) plan under part C—except where subsection (c)(3) of section 1851 already provides otherwise. In short, it is a straight funding restriction intended to stop agency actions that would make MA the default option for beneficiaries who do not actively choose a plan.
The practical effect would be operational and immediate: CMS could not obligate or spend covered HHS funds on programs, systems, or administrative practices that result in automatic enrollment into MA for non‑responsive beneficiaries. The bill does not amend the Medicare statute directly; it achieves policy change by cutting off specified appropriated dollars for the current fiscal year.
At a Glance
What It Does
The bill forbids HHS from using funds provided by previous Appropriations Acts for obligations or expenditures in the current fiscal year to carry out any activity that treats a beneficiary’s failure to elect as an election into a Medicare Advantage plan, subject only to the exception listed in 1851(c)(3). It uses a funding prohibition—“notwithstanding any other provision of law”—rather than an amendment to Medicare’s enrollment rules.
Who It Affects
Centers for Medicare & Medicaid Services (CMS) and HHS program offices that run enrollment systems, private Medicare Advantage plans and their enrollment vendors, and beneficiaries who are enrolled in Part A and Part B but do not actively choose a plan during election periods. Contractors that operate enrollment platforms and outreach programs would also be directly affected.
Why It Matters
Appropriations riders like this are a blunt but effective lever to halt agency policy changes without rewriting substantive law. If enforced, the measure would preserve Original Medicare as the default outcome for non‑responsive beneficiaries and constrain CMS’s ability to pilot or implement automatic‑assignment policies that shift enrollment into MA plans.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill is a single appropriations-style prohibition aimed at preventing HHS from treating silence as consent to enroll in Medicare Advantage. It does that by saying that none of the funds previously appropriated to HHS that are still available for obligation or expenditure in the current fiscal year may be used for any activity that would “deem” a Part A and Part B enrollee who fails to make an election under section 1851(e)(1) to have chosen an MA plan—except where subsection (c)(3) of section 1851 already authorizes a particular deeming rule.
That is procedural: it stops the agency from spending money on actions that would produce automatic MA enrollment.
Because the bill operates through funding restrictions, it does not directly rewrite Medicare’s statutory election framework. Instead it disables HHS from implementing or financing the administrative steps—systems changes, automated enrollment routines, contractor tasks, outreach scripts or rulemakings—that would make an MA plan the practical default.
In practice that could mean pausing pending guidance, halting IT changes in the Medicare Enrollment systems, and instructing contractors not to proceed with automatic‑assignment work tied to those funds.The prohibition is explicitly tied to funds “made available by previous Appropriations Acts” and to obligations or expenditures “in the current fiscal year,” so its bite is temporal and dependent on the pool of appropriated dollars still available. The bill’s “notwithstanding any other provision of law” language signals that it is intended to override other statutory authorities that might otherwise permit automatic enrollment practices.
The single statutory carve‑out it preserves is what appears in subsection (c)(3) of section 1851; the bill does not alter that carve‑out or define it further.Operationally, the most immediate effects would fall on CMS deployment schedules, enrollment vendors, and communications to beneficiaries. CMS would need to identify which activities qualify as prohibited “deeming” activities and stop using covered funds for those tasks; private plans and vendors that rely on agency processes to carry out enrollments would need revised instructions.
The bill does not create a private right of action or specify penalties; enforcement would come through controlling agency obligations and possibly through appropriations oversight or litigation over unlawfully spent funds.
The Five Things You Need to Know
The bill forbids HHS from using funds provided by previous Appropriations Acts and available for obligation or expenditure in the current fiscal year to carry out any activity that treats a failure to elect under 1851(e)(1) as an election into a Medicare Advantage plan, except as provided in 1851(c)(3).
It is a funding prohibition, not an amendment to the Medicare statute—its effect flows from restricting agency spending rather than changing the text of title XVIII. , The restriction applies only to funds from prior appropriations that are being obligated or expended in the current fiscal year, making the measure time‑bounded and tied to available funding pools. , The bill uses “notwithstanding any other provision of law,” indicating the intent to override other statutory authorities that might permit automatic or default enrollment into MA. , The statutory exception referenced—subsection (c)(3) of section 1851—is retained by the bill but is neither expanded nor explained; compliance hinges on correctly identifying activities that fall outside that exception.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Prohibits using previously appropriated HHS funds to make MA the default
This clause is the operative text: it bars obligation or expenditure of funds made available by previous Appropriations Acts to HHS for any activity that would deem a Part A/Part B enrollee who fails to make an election under 1851(e)(1) to have elected a Medicare Advantage plan, except as provided in 1851(c)(3). Practically, this forces the agency to stop or reprogram any work—rulemaking, IT change, or administrative process—financed by the affected appropriation streams that would result in automatic MA enrollment.
Scope limited to funds available for the current fiscal year
The prohibition applies only to funds from prior appropriations that HHS will obligate or spend in the current fiscal year. That makes the restriction temporary and dependent on which appropriation accounts retain unobligated funds. Agencies will need to map activities to specific appropriation lines to determine whether the restriction applies, creating immediate compliance and accounting tasks.
“Notwithstanding” language and the statutory carve‑out
By stating the rule will apply “notwithstanding any other provision of law,” the bill signals that it is meant to override conflicting authorities, including any statutory rules or existing CMS policies that could be interpreted as allowing deeming into MA. The text preserves one exception—subsection (c)(3) of section 1851—so HHS must treat that subsection as a permitted route for any deeming activity. That creates a narrow legal line HHS must analyze when deciding whether a particular activity is prohibited.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Beneficiaries who do not actively choose a plan and prefer Original Medicare — they would not be auto‑shifted into Medicare Advantage through agency action paid for with the covered funds, preserving access to fee‑for‑service coverage.
- Consumer and patient advocacy groups that prioritize active, informed enrollment decisions — the prohibition reduces the risk of inadvertent or passive enrollment in private plans without affirmative consent.
- Organizations concerned about MA market growth driven by administrative defaults — insurers’ organic enrollment gains via agency defaults would be constrained, reducing an administrative channel for market shifts.
Who Bears the Cost
- CMS and HHS program offices — they must identify covered funds, halt or reprogram prohibited activities, and potentially delay system upgrades or pilots that rely on those funds, increasing short‑term administrative burden.
- Medicare Advantage plans and their enrollment vendors — plans that expected automatic or default enrollments funded indirectly by HHS activities could face lower or delayed enrollments and must adapt operationally to changes in agency processes.
- Enrollment vendors and contractors — contractors handling automated enrollment, assignment algorithms, or outreach tied to the covered funds may lose work or need to change contracts and deliverables, creating compliance and contractual renegotiation costs.
Key Issues
The Core Tension
The bill confronts a real trade‑off: protecting beneficiaries from being passively steered into private Medicare Advantage plans versus preserving an agency’s flexibility to use administrative defaults or streamlined enrollment practices that can increase continuity of coverage or program efficiency. Stopping defaults protects choice but can also block potentially beneficial administrative fixes that rely on deeming to prevent coverage gaps.
The bill’s central operational lever—cutting off appropriated funds—is potent but blunt. It leaves open what qualifies as an “activity that deems” a beneficiary to have elected MA.
Does targeted outreach that fills an enrollment form on a beneficiary’s behalf count? What about system defaults in beneficiary portals or enrollment files transferred from employers or unions?
Those are plausible sources of dispute and would require HHS to draw fine lines between permissible administrative tasks and forbidden deeming activities.
Because the measure attaches to funds “available for obligation or expenditure in the current fiscal year,” its practical lifespan and coverage will vary with agency accounting. Some HHS activities are financed out of multi‑year accounts or mandatory trust fund transfers; determining whether those funding streams are covered will be a technical but decisive exercise.
Finally, the bill preserves the subsection (c)(3) exception without defining it, which concentrates legal attention on that carve‑out and invites litigation or contested agency interpretations about whether specific practices fit inside it.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.