AB 163

This bill makes various changes to eligibility determinations for the Medical Assistance program. Currently, the Department of Health Services administers the Medical Assistance program, a joint federal and state program that provides health services to individuals who have limited financial resources.

The bill prohibits DHS from automatically renewing the eligibility of a recipient under the Medical Assistance program. DHS must determine an individual’s eligibility every six months under the bill. DHS is also prohibited from using prepopulated forms or otherwise supplying information, except for name and address, to a recipient under the Medical Assistance program that has been supplied to DHS. Additionally, any recipient under the Medical Assistance program that fails to report to DHS or its designee any change that may affect eligibility within 10 days following such a change is ineligible for benefits for six months from the date DHS discovers the failure to report the change. Under current law, knowingly concealing or failing to disclose any event that an individual knows affects the initial or continued right to a Medical Assistance benefit is subject to a forfeiture of not less than $100 nor more than $15,000 for each concealment or failure. If DHS determines that it is necessary to obtain permission from the federal Department of Health and Human Services to implement any portion of the bill with respect to the Medical Assistance program, the bill requires DHS to request any state plan amendment, waiver of federal law, or other federal approval necessary to implement that portion of the bill.

The bill requires DHS to enter into data-sharing agreements with any agency that maintains a database of financial or personal information about residents of this state. DHS must confirm the information of an applicant for a public assistance program against the information contained in those databases. The bill also requires DHS to share data for the purpose of confirming eligibility for public assistance programs. Current law requires DHS and the Department of Children and Families to compare each department’s respective databases against the databases of death records to identify deceased participants.

The bill directs DHS to complete a redetermination of eligibility for all recipients of Medical Assistance and immediately remove from Medical Assistance any recipient who is ineligible before January 1, 2026. For all such individuals removed from the Medical Assistance program, the bill directs DHS to inform them of the availability of coverage under a qualified health plan that is offered through an American health benefit exchange and that they may be eligible for premium assistance.