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139 STAT. 306 PUBLIC LAW 119–21—JULY 4, 2025 SEC. 71118. REQUIRING BUDGET NEUTRALITY FOR MEDICAID DEM- ONSTRATION PROJECTS UNDER SECTION 1115. (a) IN GENERAL.—Section 1115 of the Social Security Act (42 U.S.C. 1315) is amended by adding at the end the following new subsection: ‘‘(g) REQUIREMENT OF BUDGET NEUTRALITY FOR MEDICAID DEM- ONSTRATION PROJECTS.— ‘‘(1) IN GENERAL.—Beginning January 1 2027, the Secretary may not approve an application for (or renewal or amendment of) an experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of title XIX in a State (in this subsection referred to as a ‘Medicaid dem- onstration project’) unless the Chief Actuary for the Centers for Medicare & Medicaid Services certifies that such project, or, in the case of a renewal, the duration of the preceding waiver, is not expected to result in an increase in the amount of Federal expenditures compared to the amount that such expenditures would otherwise be in the absence of such project. For purposes of this subsection, expenditures for the coverage of populations and services that the State could have otherwise provided through its Medicaid State plan or other authority under title XIX, including expenditures that could be made under such authority but for the provision of such services at a different site of service than authorized under such State plan or other authority, shall be considered expenditures in the absence of such a project. ‘‘(2) TREATMENT OF SAVINGS.—In the event that expendi- tures with respect to a State under a Medicaid demonstration project are, during an approval period for such project, less than the amount of such expenditures that would have other- wise been made in the absence of such project, the Secretary shall specify the methodology to be used with respect to the subsequent approval period for such project for purposes of taking the difference between such expenditures into account.’’. (b) IMPLEMENTATION FUNDING.—For the purposes of carrying out the provisions of, and the amendments made by, this section, there are appropriated, out of any monies in the Treasury not otherwise appropriated, to the Administrator of the Centers for Medicare & Medicaid Services, $5,000,000 for each of fiscal years 2026 and 2027, to remain available until expended. Subchapter D—Increasing Personal Accountability SEC. 71119. REQUIREMENT FOR STATES TO ESTABLISH MEDICAID COMMUNITY ENGAGEMENT REQUIREMENTS FOR CER- TAIN INDIVIDUALS. (a) IN GENERAL.—Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by sections 71103 and 71104, is further amended by adding at the end the following new subsection: ‘‘(xx) COMMUNITY ENGAGEMENT REQUIREMENT FOR APPLICABLE INDIVIDUALS.— ‘‘(1) IN GENERAL.—Except as provided in paragraph (11), beginning not later than the first day of the first quarter that begins after December 31, 2026, or, at the option of the State under a waiver or demonstration project under section 1115 or the State plan, such earlier date as the State may specify, subject to the succeeding provisions of this subsection, Deadline. Time periods. Time periods. Effective date. Certification.