The House Committee on Health offers the following substitute to HB 1276:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public
assistance, so as to provide for the Department of Human Services to regularly and
systematically review information from certain sources to determine and verify eligibility of
Medicaid recipients; to prohibit self-attestation of certain eligibility factors; to provide for
consent to disclosure of certain information; to provide for Medicaid program integrity
measures; to provide for certain state agencies to submit information to the department; to
provide for the department to request information from certain federal agencies; to provide
for the review of data; to provide for the removal of ineligible recipients; to provide for
eligibility redeterminations; to provide for retroactive eligibility; to provide for annual
reports; to provide for supplemental data to such reports; to provide for related matters; to
provide for the Department of Community Health to submit a state plan amendment or
waiver request; to provide for an effective date; to repeal conflicting laws; and for other
purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,
is amended by adding a new article to read as follows:
<ins>"ARTICLE 10
49-4-200.
(a) Except as required under federal law, self-attestation shall not be accepted for any of
the following in the administration of the Medicaid program pursuant to Article 7 of this
chapter without verification prior to enrollment:
(1) Income;
(2) Residency;
(3) Identity;
(4) Household composition; and
(5) Citizenship or immigration status.
(b) Except as required under federal law, a condition of eligibility for assistance shall be
that a Medicaid recipient consent to the disclosure of information about such individual's
income, residency, identity, household composition, and citizenship or immigration status.
Such consent shall be effective to authorize any state or federal agency to release such
information requested by the department as provided for in this article.
49-4-201.
The Department of Community Health and the department shall coordinate the issuing of
requests to applicable state agencies and federal agencies for information relating to
Medicaid eligibility data, including, but not limited to:
(1) Medicaid recipient identity verification;
(2) Medicaid recipient death verification;
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<ins>(3) Employment and wages;
(4) Lottery winnings;
(5) Residency verification, including residency relating to concurrent enrollment in
Medicaid programs in other states;
(6) Household composition;
(7) Medicaid recipient incarceration status;
(8) Third-party liability verification;
(9) Asset verification; and
(10) Any other data the Department of Community Health or the department considers
appropriate in order to strengthen program integrity, reduce costs, and reduce fraud,
waste, and abuse in the Medicaid program.
49-4-202.
(a) The department shall enter into any data-sharing agreements or memorandums of
understanding with any state or federal agencies necessary to effectuate the provisions of
this article.
(b) The department shall develop a form, identify information, and establish a schedule for
the Department of Labor, Department of Revenue, and Department of Corrections to
submit information to the department as provided for in Code Section 49-4-203.
(c) The department shall be authorized to contract with an independent third party for
database searches that may contain information that may indicate a change in
circumstances affecting Medicaid recipient eligibility.
49-4-203.
(a) No later than January 1, 2027, and on a monthly basis thereafter, the Department of
Corrections shall submit information concerning Medicaid recipients, including regarding
incarceration, to the department.
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<ins>(b) No later than January 1, 2027, and on a quarterly basis thereafter, the Department of
Labor and the Department of Revenue shall submit information concerning Medicaid
recipients, including changes to employment or wages, to the department.
(c) No later than January 1, 2027, and on an annual basis thereafter, the Department of
Revenue shall submit information concerning Medicaid recipients, including adjusted gross
income and family composition, to the department.
(d) The department shall promptly review the information received pursuant to subsections
(a), (b), and (c) of this Code section for indications of changes in circumstances affecting
Medicaid recipient eligibility and shall take any actions provided for in Code Section
49-4-206 as necessary.
49-4-204.
(a) On at least a monthly basis, the department shall request information concerning
Medicaid recipients that may indicate a change in circumstances affecting the eligibility
of such recipients from the following federal agencies:
(1) The federal Social Security Administration, including, but not limited to, earned
income information, death registry information from the Master Death File, incarceration
records, supplemental security income information, beneficiary records, earnings
information, and pension information;
(2) The United States Department of Health and Human Services, including, but not
limited to, income and employment information maintained in the National Directory of
New Hires database and any child support enforcement data;
(3) The United States Postal Service, including, but not limited to, information to
identify a change in residence;
(4) The United States Department of Housing and Urban Development, including, but
not limited to, income and residency information; and
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<ins>(5) The Federal Bureau of Investigation, including, but not limited to, information from
the National Crime Information Center to identify fleeing felons.
(b) On at least an annual basis, the department shall request information from the Internal
Revenue Service that may indicate a change in circumstances affecting the eligibility of
Medicaid recipients, including, but not limited to, tax filing data, adjusted gross income,
and family composition.
(c) The department shall promptly review the information received pursuant to subsections
(a) and (b) of this Code section for indications of changes in circumstances affecting
Medicaid recipient eligibility and shall take any actions provided for in Code Section
49-4-206 as necessary.
(d) The department shall fully implement the provisions of subsection (c) of this Code
section as it pertains to information received pursuant to paragraph (1) of subsection (a) of
this Code section no later than January 1, 2027, and shall fully implement the provisions
of subsection (c) of this Code section as it pertains to information received pursuant to
paragraph (3) of subsection (a) of this Code section no later than October 1, 2029.
49-4-205.
(a) Except as required by federal law, the department shall conduct eligibility
redeterminations at least once every 12 months for all nonelderly adult Medicaid recipients
whose eligibility is determined using Modified Adjustment Gross Income standards
pursuant to 42 C.F.R. Section 435.603.
(b) The department shall conduct eligibility redeterminations at least once every 12 months
for all Medicaid recipients not provided for in subsection (a) of this Code section and shall
take any actions provided for in Code Section 49-4-206 as necessary.
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<ins>49-4-206.
(a) Except as provided for in subsections (b) and (c) of this Code section, Medicaid
recipients who are determined by the department to be ineligible shall be subject to
disenrollment and removal in accordance with federal notice requirements.
(b) The department shall immediately remove from Medicaid enrollment any individual
confirmed to be deceased.
(c) The department shall immediately suspend from active Medicaid enrollment any
individual confirmed as a fleeing felon or confirmed as incarcerated in accordance with
federal requirements.
49-4-207.
(a) As used in this Code section, the term 'retroactive eligibility' means Medicaid coverage
for services provided prior to the month in which an individual submits an application for
Medicaid, as authorized by 42 U.S.C. Section 1396a(a)(34).
(b) Except as provided in federal law, the Department of Community Health shall limit
retroactive eligibility for Medicaid benefits such that Medicaid coverage may be provided
no more than two months prior to the month in which an individual submits a completed
Medicaid application. Such limitation shall only apply to initial applications for Medicaid
and shall not affect eligibility for continuous or ongoing coverage.
49-4-208.
No later than January 31, 2027, and annually thereafter, the Department of Community
Health shall submit a report regarding the implementation and effect of this article to the
Governor, the President of the Senate, the Speaker of the House of Representatives, the
chairpersons of the House Committee on Appropriations and the Senate Appropriations
Committee, and the chairpersons of the House Committee on Public and Community
Health and the Senate Health and Human Services Committee. Such report shall include
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<ins>any data on changes in eligibility determinations for Medicaid recipients, removals from
enrollment, referrals to fraud investigation or prosecution, data-sharing agreements,
third-party contracts, costs and expenses, improper payments and expenditures, moneys
recovered, and revenue savings related to the implementation of this article. Such report
shall be promptly updated when supplemental data is requested by the Governor, the
President of the Senate, the Speaker of the House of Representatives, or such chairpersons."
</ins> SECTION 2.
If necessary to implement the provisions of this Act, the Department of Community Health
shall submit a Medicaid state plan amendment or waiver request to the Centers for Medicare
and Medicaid Services of the United States Department of Health and Human Services.
SECTION 3.
This Act shall become effective January 1, 2027.
SECTION 4.
All laws and parts of laws in conflict with this Act are repealed.