SB460: SB460 Department of Community Health; determine and verify eligibility of Medicaid applicants and Medicaid recipients and to manage Medicaid enrollment; provide

Right now, the Department of Human Services determines whether Georgians qualify for Medicaid, while the Department of Community Health oversees the broader Medicaid program. This bill would move eligibility determinations, enrollment management, and related fund administration for Medicaid entirely to the Department of Community Health, effective July 1, 2027. The bill requires the two agencies to cooperate so people do not lose care during the transition. It sets rules for how eligibility is checked, including that applying for Medicaid means consenting to let the state check income, residency, employment and other records. It also lays out notice requirements for people found ineligible, referral to prosecution for suspected fraud, and directs Community Health to seek any needed federal approval (a state plan amendment or waiver) to make the change. The law would take effect as soon as the Governor signs it, though the actual transfer of duties happens in 2027.

• Transfers Medicaid eligibility determinations 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 (and, until 2027, Human Services) to verify eligibility before approving benefits and during periodic recheck of current recipients.
• Requires that applying for Medicaid counts as consent to let state and federal agencies share personal information like income, residency, and employment records with the reviewing department.
• Requires the department to regularly recheck circumstances that could make a recipient ineligible and refer suspected fraud, waste, or abuse for prosecution.
• Requires notice to applicants or recipients found ineligible, including information about appeals and other low-cost health coverage options.
• Directs the Department of Community Health to request any necessary federal approval, such as a state plan amendment or waiver, to carry out the changes.

Medicaid applicants and recipients in Georgia, the Department of Human Services and the Department of Community Health, county welfare offices, and any vendors or agencies that share data with the state to verify eligibility or investigate fraud.

Georgians applying for or currently on Medicaid would eventually deal with a different state agency for eligibility decisions, more frequent eligibility checks, and mandatory information-sharing across agencies. People found ineligible would face disenrollment, though with required notice and appeal information.

• Section 1 rewrites the Department of Community Health's mission (O.C.G.A. § 31-2-1) to include determining Medicaid eligibility and using data analytics and investigations to manage enrollment and prevent fraud.
• Sections 2 and 3 set July 1, 2027 as the date the Department of Human Services' Medicaid-related powers transfer to the Department of Community Health.
• Section 4 lets the Department of Community Health administer and disburse funds for Medicaid after the transfer date.
• Sections 5 and 6 update the Department of Human Services' powers and appropriations language to carve out Medicaid duties after July 1, 2027.
• Section 8 narrows the legal definition of 'public assistance' so it no longer includes Medicaid after the transfer.
• Section 9 requires the Department of Human Services to fully cooperate with Community Health to ensure continuity of care during the handoff.
• Section 11 creates a new Code section (49-4-143.1) requiring eligibility verification, consent to data disclosure, regular rechecks, fraud referrals, and notice to ineligible applicants or recipients.
• Section 12 requires the Department of Community Health to seek any federal approval needed, such as a state plan amendment or waiver, and Section 13 sets the effective date as upon the Governor's signature.

1. 2026-02-05Senate Read and Referred (Senate)
2. 2026-02-04Senate Hopper (Senate)

• Blake Tillery (R, SD-019)Primary sponsor
• Randy Robertson (R, SD-029)
• Larry Walker (R, SD-020)
• Ben Watson (R, SD-001)

• Medicaid
• health care eligibility
• state agency reorganization
• public assistance fraud
• Georgia Department of Community Health