Bill > HB1156

This bill amends the Human Services Code to enhance verification of eligibility for medical assistance (Medicaid) by establishing several new data-sharing and review requirements. The Pennsylvania Department of Human Services must now enter into data matching agreements with multiple state agencies to regularly review potential changes in recipients' circumstances, including monthly checks of gambling winnings over $3,000, monthly reviews of death records from the Department of Health, quarterly reviews of employment and wage information from the Department of Labor and Industry, monthly reviews of out-of-state electronic benefit transfer (EBT) transactions for potential residency changes, monthly reviews of information from the Department of Corrections, and quarterly reviews of tax records from the Department of Revenue. The bill also prohibits the department from accepting self-attestation of income, residency, and other key eligibility factors without prior verification, prevents the department from designating itself as a qualified health entity for presumptive eligibility determinations, and requires independent verification of eligibility even when assessments come from health insurance exchanges. Additionally, the bill allows the department to contract with independent vendors for additional data and mandates that any information suggesting a change in circumstances triggering potential ineligibility must be thoroughly reviewed. The new provisions aim to reduce potential fraud and ensure more accurate medical assistance program enrollment.

Health and Social Services

https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=1156