---
title: SB 460. Department of Community Health; determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; provide
collection: bills
id: 2025-2026/sb460
cite_as: SB 460, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/sb460
md_url: https://georgiacommons.org/bills/2025-2026/sb460.md
text_url: https://georgiacommons.org/bills/2025-2026/sb460/text
source_url: https://www.legis.ga.gov/legislation/72832
date: 2026-02-05
status: introduced
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 95
omitted_url: https://georgiacommons.org/bills/2025-2026/sb460.md?full=1
bill_number: SB 460
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: Senate
bill_type: bill
status_date: 2026-02-04
last_action: Senate Read and Referred
sponsors:
- Blake Tillery
- Randy Robertson
- Larry Walker
- Ben Watson
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/SB460/2025
upstream_id: 2108101
summaries_model: claude-sonnet-5
topic_tags:
- Medicaid eligibility
- state agency reorganization
- public assistance fraud
- health care coverage
- government data sharing
---
# SB 460. Department of Community Health; determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; provide
## Text
Senate Bill 460
By: Senators Tillery of the 19th, Robertson of the 29th, Walker III of the 20th and Watson
of the 1st
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 2 of Title 31 and Chapters 2 and 4 of Title 49 of the Official Code of
Georgia Annotated, relating to the Department of Community Health, Department of Human
Services, and public assistance, respectively, so as to provide for the Department of
Community Health to determine and verify eligibility of Medicaid applicants and Medicaid
recipients and to manage Medicaid enrollment; to transfer certain powers, functions, and
duties from the Department of Human Services to the Department of Community Health; to
provide for the Department of Community Health to administer, expend, and disburse funds;
to provide for cooperation and continuity of care and services; to provide for consent to
disclosure of certain information; to provide for the Department of Community Health to
request and review information for changes in circumstances that may affect ineligibility;
to provide for notice; to provide for removal of ineligible Medicaid recipients; to provide for
referral for prosecution; to provide for related matters; to provide for 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 2 of Title 31 of the Official Code of Georgia Annotated, relating to Department of
Community Health, is amended in Code Section 31-2-1, relating to legislative intent and
grant of authority, by revising paragraph (1) as follows:
"(1) Serve as the lead planning agency for all health issues in the state to remedy the
current situation wherein the responsibility for health care policy, purchasing, planning,
and regulation is spread among many different agencies; and achieve determinations of
Medicaid eligibility for inmates to attain services at long-term care facilities when he or
she is being considered for parole; determine and verify eligibility for Medicaid
applicants and Medicaid recipients; and use data analytics, audits, screenings,
investigations, and prosecutions to manage Medicaid enrollment to prevent fraud, waste,
and abuse;"
SECTION 2.
Said chapter is further amended in paragraph (1) of subsection (a) of Code Section 31-2-4,
relating to powers, duties, functions, and responsibilities, divisions, directors, and contracts
for health benefits, by adding a new subparagraph to read as follows:
"(C) On and after July 1, 2027, the powers, functions, and duties of the Department of
Human Services relating to the Medicaid program, Medicaid eligibility determinations,
and Medicaid enrollment shall be performed and exercised by the Department of
Community Health pursuant to paragraph (1) of Code Section 31-2-1."
SECTION 3.
Chapter 2 of Title 49 of the Official Code of Georgia Annotated, relating to the Department
of Human Services, is amended in Code Section 49-2-1, relating to department created,
transfer from Department of Human Resources, commissioner, and kinship care enforcement
administrator, by revising subsection (a) as follows:
"(a)(1) There is created a Department of Human Services. The powers, functions, and
duties of the Department of Human Resources as they existed on June 30, 2009, except
for those relating to the Division of Mental Health, Developmental Disabilities, and
Addictive Diseases, the Division of Public Health, and the Office of Regulatory Services,
unless specifically transferred or reassigned to the Department of Community Health or
the Department of Behavioral Health and Developmental Disabilities, are transferred to
the Department of Human Services effective July 1, 2009, and the Department of Human
Resources shall be reconstituted as the Department of Human Services effective July 1,
2009.
(2) On and after July 1, 2027, the powers, functions, and duties of the Department of
Human Services relating to the Medicaid program, Medicaid eligibility determinations,
and Medicaid enrollment shall be performed and exercised by the Department of
Community Health pursuant to subparagraph (a)(1)(C) of Code Section 31-2-4."
SECTION 4.
Said chapter is further amended by revising Code Section 49-2-5, relating to department is
institution of state, and power to disburse state, county, and federal funds, as follows:
"49-2-5.
The department is declared to be an institution of the state for which the powers of taxation
over the whole state may be exercised, and the department is empowered and authorized
to administer, expend, and disburse funds appropriated to it and allocated to it by the
General Assembly, the respective counties of the state, and the United States, through its
appropriate agencies and instrumentalities for the purpose of distributing old-age benefits
and all other benefits as provided in this title; provided, however, that, on and after July 1,
2027, the Department of Community Health is empowered and authorized to administer,
expend, and disburse such funds for the purpose of administering the Medicaid program,
including Medicaid eligibility determinations and Medicaid enrollment management."
SECTION 5.
Said chapter is further amended by revising subparagraph (b)(1)(A) and paragraph (5) of
subsection (b) of Code Section 49-2-6, relating to powers and duties, as follows:
"(A) All categories of public assistance established under Code Section 49-4-3;
provided, however, that, on and after July 1, 2027, the Department of Community
Health shall administer and supervise the Medicaid program, including, but not limited
to, Medicaid eligibility determinations and Medicaid enrollment management;"
"(5) Act as the agent of the federal government in welfare matters of mutual concern in
conformity with this title and the administration of any federal funds granted to the state
to aid in the furtherance of any functions of the department; provided, however, that, on
and after July 1, 2027, the Department of Community Health shall administer and
supervise the Medicaid program, including, but not limited to, Medicaid eligibility
determinations and Medicaid enrollment management;"
SECTION 6.
Said chapter is further amended by revising Code Section 49-2-10, relating to state
appropriations and state, county, and federal welfare funds are for public purpose, as follows:
"49-2-10.
For the purpose of carrying out the duties and obligations of the department for
performance of welfare services of the state, for administrative costs, for matching such
federal funds as may be available for all of the aforesaid services, for the purpose of
establishing an equalization fund to be used in assisting those counties which may be
unable otherwise to bear their proportionate share of the expenses of administration and of
dispensing the benefits provided for under this title, and for dispensing all of the benefits
provided for under this title, the General Assembly shall make appropriations out of the
general fund of the state or otherwise for the various and separate activities of the
department. All funds appropriated or allocated to the department or to the county
departments by the General Assembly, the fiscal authorities of the respective counties, and
by the federal government through its appropriate agencies and instrumentalities are
declared to be funds provided for a public purpose; and all appropriations provided for in
this Code section and hereafter may be expended and distributed by the department for the
purposes provided for under this title; provided, however, that, on and after July 1, 2027,
the Department of Community Health shall expend and distribute such funds as they
pertain to the Medicaid program, including, but not limited to, Medicaid eligibility
determinations and Medicaid enrollment management."
SECTION 7.
Said chapter is further amended in Code Section 49-2-11, relating to acceptance and
disbursement of federal aid, compliance with conditions, and use of appropriations for
matching funds, by revising subsection (f) as follows:
"(f) Notwithstanding subsections (a) through (e) of this Code section, the The Department
of Community Health shall be the single state agency for the administration of the state
medical assistance plan, and on and after July 1, 2027, shall determine and verify Medicaid
eligibility and manage Medicaid enrollment."
SECTION 8.
Chapter 4 of said title, relating to public assistance, is amended by revising paragraph (2) of
Code Section 49-4-2, relating to definitions, as follows:
"(2) 'Public assistance' means payment in or by money, medical care, remedial care, goods,
or services to or for the benefit of needy persons under any categories that may be
established pursuant to this article; provided, however, that, on and after July 1, 2027, such
term shall not include medical assistance provided for under the Medicaid program."
SECTION 9.
Said chapter is further amended in Code Section 49-4-3, relating to establishment of
categories of public assistance and powers and duties in administration of article, by adding
a new subsection to read as follows:
"(c) On and after July 1, 2027, all powers, functions, and duties relative to administration
of and eligibility determinations for the Medicaid program shall be transferred from the
department to the Department of Community Health; provided, however, that the
department shall provide for maximum cooperation with the Department of Community
Health to ensure continuity of care and services provided under the Medicaid program."
SECTION 10.
Said chapter is further amended in Code Section 49-4-142, relating to Department of
Community Health established, adoption, administration, modification of state plan, drug
application fees, and personal needs allowance, by revising subsection (a) as follows:
"(a) The Department of Community Health established under Chapter 2 of Title 31
department is authorized to adopt and administer a state plan for medical assistance in
accordance with Title XIX of the federal Social Security Act, as amended (Act of July 30,
1965, P.L. 89-97, 79 Stat. 343, as amended), provided such state plan is administered
within the appropriations made available to the department. The department is authorized
to establish the amount, duration, scope, and terms and conditions of eligibility for and
receipt of such medical assistance as it may elect to authorize pursuant to this article. The
department shall regularly and systematically review eligibility determinations. Further,
the department is authorized to establish such rules and regulations as may be necessary
or desirable in order to execute the state plan and to receive the maximum amount of
federal financial participation available in expenditures made pursuant to the state plan;
provided, however, that the department shall establish reasonable procedures for notice to
interested parties and an opportunity to be heard prior to the adoption, amendment, or
repeal of any such rule or regulation. The department is authorized to enter into such
reciprocal and cooperative arrangements with other states, persons, and institutions, public
and private, as it may deem necessary or desirable in order to execute the state plan."
SECTION 11.
Said chapter is further amended by adding a new Code section to read as follows:
"49-4-143.1.
(a) Except as prohibited by federal law, the department shall determine and verify all
conditions of eligibility for medical assistance before authorization of medical assistance
for a Medicaid applicant and during regular reevaluation of a Medicaid recipient's
eligibility for medical assistance.
(b) By applying for medical assistance, an individual consents to the disclosure of
information about the identity, age, residence, citizenship, employment, applications for
employment, income, wages, assets, and resources of the individual or available to the
individual that are in the possession of state and federal agencies. Such consent shall be
effective to authorize any state and federal agencies to release such information requested
by the department.
(c) The department shall regularly request and review information concerning Medicaid
recipients that may indicate a change in circumstances that affect eligibility. Any
information indicating fraud, waste, or abuse shall be referred to prosecution pursuant to
Code Sections 49-4-15 and 49-4-146.1 and Article 7B of this chapter.
(d) Medicaid applicants who are determined by the department to be ineligible shall be
promptly informed of such ineligibility in accordance with federal guidelines. Medicaid
recipients who are determined by the department to be ineligible shall be subject to
disenrollment and removal in accordance with federal notice requirements. The
department shall inform any ineligible Medicaid applicants or Medicaid recipients of any
appeals processes and the availability of discounted or reduced cost healthcare coverage
or healthcare services from other sources.
(e) The department shall enter into any data sharing agreements or memorandums of
understanding with any governmental agencies to effectuate the provisions of this Code
section. The department is authorized to contract with vendors to process applications,
verify data, or manage technical systems to support the provisions of this Code section."
SECTION 12.
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 13.
This Act shall become effective upon its approval by the Governor or upon its becoming law
without such approval.
SECTION 14.
All laws and parts of laws in conflict with this Act are repealed.
## Summaries written by Georgia Commons
The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.
Senate Bill 460 would shift responsibility for deciding who qualifies for Medicaid in Georgia from the Department of Human Services to the Department of Community Health, starting July 1, 2027, and add new eligibility checks and fraud referral rules.
### Plain-language summary
Right now the Department of Human Services determines Medicaid eligibility while the Department of Community Health oversees the broader Medicaid program. This bill moves the eligibility determination and enrollment management job to the Department of Community Health, effective July 1, 2027. It rewrites several sections of Georgia law (O.C.G.A. Title 31, Chapter 2 and Title 49, Chapters 2 and 4) so that the Department of Community Health takes over administering, spending, and disbursing Medicaid funds, and the Department of Human Services is directed to cooperate to keep care and services continuous during the transition.
The bill also creates a new Code section requiring the department to verify applicants' eligibility before approving benefits and to periodically recheck current recipients' eligibility. Applying for Medicaid would count as consenting to let state and federal agencies share personal information such as income, employment, and residency. Cases showing possible fraud, waste, or abuse would be referred for prosecution, and people found ineligible would be notified and could be disenrolled. The state would also seek any needed federal approval (a state plan amendment or waiver) to carry out these changes.
### What it does
- Transfers Medicaid eligibility determination, verification, and enrollment management from the Department of Human Services to the Department of Community Health, effective July 1, 2027.
- Requires the Department of Community Health to check applicants' eligibility before approving benefits and to regularly recheck current recipients' eligibility for continued qualification.
- Treats applying for Medicaid as automatic consent to share an applicant's personal data (income, employment, residency, assets) among state and federal agencies.
- Requires cases showing possible fraud, waste, or abuse discovered during eligibility reviews to be referred for prosecution under specified Georgia code sections.
- Requires notice to applicants or recipients found ineligible, including information on appeals and other low-cost health coverage options, before disenrollment.
- Directs the Department of Community Health to pursue any needed federal approval, such as a Medicaid state plan amendment or waiver, to implement these changes.
### Who it affects
Medicaid applicants and current Medicaid recipients in Georgia, the Department of Community Health and the Department of Human Services (which must transfer duties and cooperate), county welfare offices, and outside vendors or agencies the state may contract with to verify data or manage enrollment systems.
### Why it matters
Medicaid enrollees would go through a different state agency for eligibility decisions, face more frequent rechecks of their circumstances, and have their personal data shared across agencies. People found ineligible could be removed from coverage, though they must be notified and told about appeal options and other low-cost care.
### Key provisions
- Section 1 revises O.C.G.A. ยง 31-2-1 to direct the Department of Community Health to determine and verify Medicaid eligibility and use data analytics, audits, and investigations to manage enrollment and prevent fraud.
- Sections 2 through 9 set July 1, 2027 as the date the Medicaid eligibility, enrollment, and fund administration duties move from the Department of Human Services to the Department of Community Health, while requiring cooperation for continuity of care.
- Section 7 makes the Department of Community Health the single state agency for the Medicaid plan and gives it authority to verify eligibility and manage enrollment starting in 2027.
- Section 10 requires the department to regularly and systematically review eligibility determinations for medical assistance recipients.
- Section 11 adds new Code Section 49-4-143.1, requiring eligibility verification before and during enrollment, deeming applicants to consent to data sharing, requiring referral of suspected fraud for prosecution, and requiring notice and appeal information for those found ineligible.
- Section 12 requires the Department of Community Health to seek a federal Medicaid state plan amendment or waiver if needed to carry out the Act.
- Section 13 makes the Act effective upon the Governor's signature or upon becoming law without signature, though the Medicaid duty transfer itself is set for July 1, 2027.
## Status
- Status: Introduced (2026-02-04)
- Last action: Senate Read and Referred (2026-02-05)
- Sponsors: Blake Tillery, Randy Robertson, Larry Walker, Ben Watson
- Official page: https://www.legis.ga.gov/legislation/72832
> The history, votes, and amendments (95 characters) are at https://georgiacommons.org/bills/2025-2026/sb460.md?full=1