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H.R. 10633House119th Congress (2025-2027)In Committee

Medicaid Integrity and Fiscal Accountability Act

Sponsored by August PflugerRep. August Pfluger (R-TX)
Introduced September 28, 2026

AI-Generated Summary

Updated October 2, 2026 at 5:22 AM UTC

The Medicaid Integrity and Fiscal Accountability Act amends the Medicaid provisions of the Social Security Act to require every state to name one individual who will be primarily responsible for key fiscal functions of the Medicaid program. Starting January 1, 2028, this designated agent must oversee claim processing, payment integrity, financial reporting, and compliance with federal requirements, affecting state Medicaid agencies and the federal Medicaid system.

Key Provisions

  • Each state must designate a single individual as the primary fiscal agent for Medicaid, effective Jan. 1, 2028.
  • The agent must ensure accurate and timely processing and adjudication of Medicaid claims.
  • The agent must oversee payment integrity, including fraud, waste, abuse detection, program integrity activities, and corrective actions when problems are found.
  • The agent must guarantee accurate, complete, and timely financial reporting of state Medicaid expenditures, especially those eligible for federal participation.
  • The agent must establish and maintain controls to ensure state Medicaid spending complies with all applicable federal rules.

Legislative Activity

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HouseIntro Referral Latest Action

Referred to the House Committee on Energy and Commerce.

Energy and Commerce Committee

September 28, 2026

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HouseIntro Referral

Introduced in House

September 28, 2026

HouseIntro Referral

Referred to the House Committee on Energy and Commerce.

Energy and Commerce Committee

September 28, 2026

Bill Text

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Introduced in HouseIssued September 28, 2026

I

119th CONGRESS

2d Session

H. R. 10633

IN THE HOUSE OF REPRESENTATIVES

September 28, 2026

Mr. Pfluger (for himself, Mr. Joyce of Pennsylvania, and Mr. Balderson) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend title XIX of the Social Security Act to require each State to designate a single agent responsible for certain fiscal duties under the Medicaid program.

1.

Short title

This Act may be cited as the Medicaid Integrity and Fiscal Accountability Act.

2.

Requiring single fiscal agents under Medicaid

Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—

(1)

in subsection (a)—

(A)

in paragraph (89), by striking and at the end;

(B)

in paragraph (90), by striking the period at the end and inserting ; and; and

(C)

by inserting after paragraph (90) the following new paragraph:

(91)

provide that, beginning January 1, 2028, the State shall designate an individual as the individual primarily responsible for ensuring, through the establishment of appropriate policies, procedures, monitoring systems, and corrective actions, the following with respect to the State plan (or waiver of such plan):

(A)

The processing and adjudication of claims in an accurate and timely manner.

(B)

Payment integrity, including by—

(i)

identifying and preventing fraud, waste, abuse, and improper payments;

(ii)

overseeing program integrity activities; and

(iii)

in the case that deficiencies are identified, implementing corrective actions.

(C)

Appropriate financial reporting, including by ensuring the accuracy, completeness, and timeliness of—

(i)

reporting of State expenditures under such plan or waiver;

(ii)

reporting of such expenditures that are eligible for Federal financial participation; and

(iii)

any other financial information submitted to the Secretary.

(D)

The establishment and maintenance of controls to ensure that expenditures under such plan or waiver comply with all applicable Federal requirements.

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