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The bill includes provisions that states must meet to maintain federal matching funds for the Medicaid program, as well as more strict criteria beneficiaries must meet to qualify for and maintain enrollment in government funded health care program. The law also makes significant changes to Nutrition and the Supplemental Nutrition Assistance Program (SNAP) that shifts costs to the states and reduces federal funding. 

Additional guidance to states on the approval process for the use of in-lieu of services (ILOSs) and on-going monitoring and reporting.