Ensuring deceased individuals do not remain enrolled

Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by section 71103, is further amended— (1) in subsection (a)— (A) in paragraph (87), by striking; and and inserting a semicolon; (B) in paragraph (88), by striking the period at the end and inserting; and; and (C) by inserting after paragraph (88) the following new paragraph: (89) provide that the State shall comply with the eligibility verification requirements under subsection (ww), except that this paragraph shall apply only in the case of the 50 States and the District of Columbia.; and (2) by adding at the end the following new subsection: (ww) Verification of certain eligibility criteria (1) In general For purposes of subsection (a)(89), the eligibility verification requirements, beginning January 1, 2027, are as follows: (A) Quarterly screening to verify enrollee status The State shall, not less frequently than quarterly, review the Death Master File (as such term is defined in section 203(d) of the Bipartisan Budget Act of 2013) or a successor system that provides such information needed to determine whether any individuals enrolled for medical assistance under the State plan (or waiver of such plan) are deceased. (B) Disenrollment under State plan If the State determines, based on information obtained from the Death Master File, that an individual enrolled for medical assistance under the State plan (or waiver of such plan) is deceased, the State shall— (i) treat such information as factual information confirming the death of a beneficiary; (ii) disenroll such individual from the State plan (or waiver of such plan) in accordance with subsection (a)(3); and (iii) discontinue any payments for medical assistance under this title made on behalf of such individual (other than payments for any items or services furnished to such individual prior to the death of such individual). (C) Reinstatement of coverage in the event of error If a State determines that an individual was misidentified as deceased based on information obtained from the Death Master File and was erroneously disenrolled from medical assistance under the State plan (or waiver of such plan) based on such misidentification, the State shall immediately re-enroll such individual under the State plan (or waiver of such plan), retroactive to the date of such disenrollment. (2) Rule of construction Nothing under this subsection shall be construed to preclude the ability of a State to use other electronic data sources to timely identify potentially deceased beneficiaries, so long as the State is also in compliance with the requirements of this subsection (and all other requirements under this title relating to Medicaid eligibility determination and redetermination)..

Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by section 71103, is further amended— (1) in subsection (a)— (A) in paragraph (87), by striking; and and inserting a semicolon; (B) in paragraph (88), by striking the period at the end and inserting; and; and (C) by inserting after paragraph (88) the following new paragraph: (89) provide that the State shall comply with the eligibility verification requirements under subsection (ww), except that this paragraph shall apply only in the case of the 50 States and the District of Columbia.; and (2) by adding at the end the following new subsection: (ww) Verification of certain eligibility criteria (1) In general For purposes of subsection (a)(89), the eligibility verification requirements, beginning January 1, 2027, are as follows: (A) Quarterly screening to verify enrollee status The State shall, not less frequently than quarterly, review the Death Master File (as such term is defined in section 203(d) of the Bipartisan Budget Act of 2013) or a successor system that provides such information needed to determine whether any individuals enrolled for medical assistance under the State plan (or waiver of such plan) are deceased. (B) Disenrollment under State plan If the State determines, based on information obtained from the Death Master File, that an individual enrolled for medical assistance under the State plan (or waiver of such plan) is deceased, the State shall— (i) treat such information as factual information confirming the death of a beneficiary; (ii) disenroll such individual from the State plan (or waiver of such plan) in accordance with subsection (a)(3); and (iii) discontinue any payments for medical assistance under this title made on behalf of such individual (other than payments for any items or services furnished to such individual prior to the death of such individual). (C) Reinstatement of coverage in the event of error If a State determines that an individual was misidentified as deceased based on information obtained from the Death Master File and was erroneously disenrolled from medical assistance under the State plan (or waiver of such plan) based on such misidentification, the State shall immediately re-enroll such individual under the State plan (or waiver of such plan), retroactive to the date of such disenrollment. (2) Rule of construction Nothing under this subsection shall be construed to preclude the ability of a State to use other electronic data sources to timely identify potentially deceased beneficiaries, so long as the State is also in compliance with the requirements of this subsection (and all other requirements under this title relating to Medicaid eligibility determination and redetermination)..