HB1276: HB1276 Community Health, Department of; review information from certain sources to determine and verify eligibility of Medicaid recipients; provide

26 LC 52 1051S 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 public1 assistance, so as to provide for the Department of Human Servic es to regularly and2 systematically review information from certain sources to determine and verify eligibility of3 Medicaid recipients; to prohibit self-attestation of certain eligibility factors; to provide for4 consent to disclosure of certain information; to provide for Me dicaid program integrity5 measures; to provide for certain state agencies to submit information to the department; to6 provide for the department to request information from certain federal agencies; to provide7 for the review of data; to provide for the removal of ineligibl e recipients; to provide for8 eligibility redeterminations; to provide for retroactive eligib ility; to provide for annual9 reports; to provide for supplemental data to such reports; to provide for related matters; to10 provide for the Department of Community Health to submit a stat e plan amendment or11 waiver request; to provide for an effective date; to repeal con flicting laws; and for other12 purposes.13 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14 H. B. 1276 (SUB) - 1 - 26 LC 52 1051S SECTION 1.15 Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,16 is amended by adding a new article to read as follows:17 "ARTICLE 1018 49-4-200.19 (a) Except as required under federal law, self-attestation shall not be accepted for any of20 the following in the administration of the Medicaid program pursuant to Article 7 of this21 chapter without verification prior to enrollment:22 (1) Income;23 (2) Residency;24 (3) Identity;25 (4) Household composition; and26 (5) Citizenship or immigration status.27 (b) Except as required under federal law, a condition of eligibility for assistance shall be28 that a Medicaid recipient consent to the disclosure of information about such individual's29 income, residency, identity, household composition, and citizenship or immigration status. 30 Such consent shall be effective to authorize any state or feder al agency to release such31 information requested by the department as provided for in this article.32 49-4-201.33 The Department of Community Health and the department shall coordinate the issuing of34 requests to applicable state agencies and federal agencies for information relating to35 Medicaid eligibility data, including, but not limited to:36 (1) Medicaid recipient identity verification;37 (2) Medicaid recipient death verification;38 H. B. 1276 (SUB) - 2 - 26 LC 52 1051S (3) Employment and wages;39 (4) Lottery winnings;40 (5) Residency verification, including residency relating to co ncurrent enrollment in41 Medicaid programs in other states;42 (6) Household composition;43 (7) Medicaid recipient incarceration status;44 (8) Third-party liability verification;45 (9) Asset verification; and46 (10) Any other data the Department of Community Health or the department considers47 appropriate in order to strengthen program integrity, reduce co sts, and reduce fraud,48 waste, and abuse in the Medicaid program.49 49-4-202.50 (a) The department shall enter into any data-sharing agreement s or memorandums of51 understanding with any state or federal agencies necessary to effectuate the provisions of52 this article.53 (b) The department shall develop a form, identify information, and establish a schedule for54 the Department of Labor, Department of Revenue, and Department of Corrections to55 submit information to the department as provided for in Code Section 49-4-203.56 (c) The department shall be authorized to contract with an ind ependent third party for57 database searches that may contain information that may indicat e a change in58 circumstances affecting Medicaid recipient eligibility.59 49-4-203.60 (a) No later than January 1, 2027, and on a monthly basis ther eafter, the Department of61 Corrections shall submit information concerning Medicaid recipients, including regarding62 incarceration, to the department.63 H. B. 1276 (SUB) - 3 - 26 LC 52 1051S (b) No later than January 1, 2027, and on a quarterly basis thereafter, the Department of64 Labor and the Department of Revenue shall submit information co ncerning Medicaid65 recipients, including changes to employment or wages, to the department.66 (c) No later than January 1, 2027, and on an annual basis ther eafter, the Department of67 Revenue shall submit information concerning Medicaid recipients, including adjusted gross68 income and family composition, to the department.69 (d) The department shall promptly review the information received pursuant to subsections70 (a), (b), and (c) of this Code section for indications of changes in circumstances affecting71 Medicaid recipient eligibility and shall take any actions provi ded for in Code Section72 49-4-206 as necessary.73 49-4-204.74 (a) On at least a monthly basis, the department shall request information concerning75 Medicaid recipients that may indicate a change in circumstances affecting the eligibility76 of such recipients from the following federal agencies:77 (1) The federal Social Secu rity Administration, including, but not limited to, earned78 income information, death registry information from the Master Death File, incarceration79 records, supplemental security income information, beneficiary records, earnings80 information, and pension information;81 (2) The United States Department of Health and Human Services, including, but not82 limited to, income and employment information maintained in the National Directory of83 New Hires database and any child support enforcement data;84 (3) The United States Postal Service, including, but not limit ed to, information to85 identify a change in residence;86 (4) The United States Department of Housing and Urban Development, including, but87 not limited to, income and residency information; and88 H. B. 1276 (SUB) - 4 - 26 LC 52 1051S (5) The Federal Bureau of Investigation, including, but not limited to, information from89 the National Crime Information Center to identify fleeing felons.90 (b) On at least an annual basis, the department shall request information from the Internal91 Revenue Service that may indicate a change in circumstances aff ecting the eligibility of92 Medicaid recipients, including, but not limited to, tax filing data, adjusted gross income,93 and family composition.94 (c) The department shall promptly review the information received pursuant to subsections95 (a) and (b) of this Code section for indications of changes in circumstances affecting96 Medicaid recipient eligibility and shall take any actions provi ded for in Code Section97 49-4-206 as necessary.98 (d) The department shall fully implement the provisions of sub section (c) of this Code99 section as it pertains to information received pursuant to paragraph (1) of subsection (a) of100 this Code section no later than January 1, 2027, and shall fully implement the provisions101 of subsection (c) of this Code section as it pertains to inform ation received pursuant to102 paragraph (3) of subsection (a) of this Code section no later than October 1, 2029.103 49-4-205.104 (a) Except as required by federal law, the department shall co nduct eligibility105 redeterminations at least once every 12 months for all nonelderly adult Medicaid recipients106 whose eligibility is determined using Modified Adjustment Gross Income standards107 pursuant to 42 C.F.R. Section 435.603.108 (b) The department shall conduct eligibility redeterminations at least once every 12 months109 for all Medicaid recipients not provided for in subsection (a) of this Code section and shall110 take any actions provided for in Code Section 49-4-206 as necessary.111 H. B. 1276 (SUB) - 5 - 26 LC 52 1051S 49-4-206.112 (a) Except as provided for in subsections (b) and (c) of this Code section, Medicaid113 recipients who are determined by the department to be ineligibl e shall be subject to114 disenrollment and removal in accordance with federal notice requirements.115 (b) The department shall immediately remove from Medicaid enrollment any individual116 confirmed to be deceased.117 (c) The department shall immediately suspend from active Medic aid enrollment any118 individual confirmed as a fleeing felon or confirmed as incarce rated in accordance with119 federal requirements.120 49-4-207.121 (a) As used in this Code section, the term 'retroactive eligibility' means Medicaid coverage122 for services provided prior to the month in which an individual submits an application for123 Medicaid, as authorized by 42 U.S.C. Section 1396a(a)(34).124 (b) Except as provided in federal law, the Department of Commu nity Health shall limit125 retroactive eligibility for Medicaid benefits such that Medicaid coverage may be provided126 no more than two months prior to the month in which an individual submits a completed127 Medicaid application. Such limitation shall only apply to initial applications for Medicaid128 and shall not affect eligibility for continuous or ongoing coverage.129 49-4-208.130 No later than January 31, 2027, and annually thereafter, the De partment of Community131 Health shall submit a report regarding the implementation and effect of this article to the132 Governor, the President of the Senate, the Speaker of the House of Representatives, the133 chairpersons of the House Committee on Appropriations and the S enate Appropriations134 Committee, and the chairpersons of the House Committee on Publi c and Community135 Health and the Senate Health and Human Services Committee. Such report shall include136 H. B. 1276 (SUB) - 6 - 26 LC 52 1051S any data on changes in eligibility determinations for Medicaid recipients, removals from137 enrollment, referrals to fraud investigation or prosecution, da ta-sharing agreements,138 third-party contracts, costs and expenses, improper payments an d expenditures, moneys139 recovered, and revenue savings related to the implementation of this article. Such report140 shall be promptly updated when supplemental data is requested b y the Governor, the141 President of the Senate, the Speaker of the House of Representatives, or such chairpersons."142 SECTION 2.143 If necessary to implement the provisions of this Act, the Department of Community Health144 shall submit a Medicaid state plan amendment or waiver request to the Centers for Medicare145 and Medicaid Services of the United States Department of Health and Human Services.146 SECTION 3.147 This Act shall become effective January 1, 2027.148 SECTION 4.149 All laws and parts of laws in conflict with this Act are repealed.150 H. B. 1276 (SUB) - 7 -