SB 460: 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 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.

• 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.

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.

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.

• Section 1 revises O.C.G.A. § 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.

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

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

• Medicaid eligibility
• state agency reorganization
• public assistance fraud
• health care coverage
• government data sharing