The Medicaid Accountability Act of 2023 modifies federal Medicaid payment rules for three U.S. territories: Guam, the Northern Mariana Islands, and American Samoa. Specifically, the bill excludes spending by state Medicaid fraud control units from the payment limits these territories face under Medicaid, allowing them to spend more on fraud detection without hitting federal spending caps. This change applies to fiscal years beginning after the bill's enactment. The legislation essentially gives these territories more flexibility in their Medicaid budgets when they invest in fraud prevention and enforcement activities. The bill was introduced in October 2023 and referred to the House Committee on Energy and Commerce but did not specify new funding amounts or authorization levels.