States would protect Medicaid workers who report suspected wrongdoing

States would need to assure the Secretary that they have laws protecting covered workers from job retaliation for protected disclosures. Covered workers are employees, contractors, subcontractors, or agents involved in running, overseeing, or delivering services under a State Medicaid plan or waiver. The Secretary must find the State's assurances satisfactory. A protected disclosure must go to a covered entity, and the worker must reasonably believe it shows a legal violation, misuse of public funds, gross mismanagement, abuse of authority, or a serious and specific danger to public health or safety. State compliance would begin January 1, 2028.

States would need procedures for covered workers to seek relief through an administrative process and, if they disagree with its result, judicial review. The procedures would apply to covered workers who allege job retaliation for making a protected disclosure. Available remedies would include reinstatement, twice the back pay with interest, special damages, and litigation costs and reasonable attorney fees. Punitive damages would be available only if the retaliation involved malice or reckless indifference to the worker's rights. These procedures would be part of the State protections required beginning January 1, 2028.