Ensuring Deceased Individuals Do Not Remain Enrolled
Section 71104 · Sec. 71104 ·
What this chapter is about
This part makes states check a death file every three months. Anyone found dead must be taken off Medicaid. Payments for them must stop. Someone wrongly removed must be put back at once.
“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.”
The section inserts a new paragraph (89) into section 1902(a) of the Social Security Act (42 U.S.C. 1396a) requiring a State plan to provide that the State follows the new eligibility verification requirements, which apply only to the 50 States and the District of Columbia and begin January 1, 2027.
What the document actually says
“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.”
That sentence, in plain words
The state must follow the new checking rules. Those rules sit in a new subsection. Only the 50 states and the capital are covered.
What this is about
Territories are left out of this rule. The checks begin on January 1, 2027. The older law it sits in is not indexed here.
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“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”
The section requires the State, at least quarterly, to review the Death Master File as defined in section 203(d) of the Bipartisan Budget Act of 2013, or a successor system giving the same information, to see whether anyone enrolled for medical assistance under the State plan or a waiver has died.
What the document actually says
“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 sentence, in plain words
The state must check a federal death file. That must happen at least every three months. A newer system may take its place.
What this is about
The file lists people recorded as dead. The check covers everyone on the rolls. It also covers people under a waiver.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“treat such information as factual information confirming the death of a beneficiary;”
The section requires the State, where the Death Master File shows an enrolled individual is dead, to treat that as factual confirmation of the death, to disenroll the individual under section 1902(a)(3), and to stop payments for medical assistance on that person's behalf other than for items or services provided before the death.
What the document actually says
“treat such information as factual information confirming the death of a beneficiary;”
That sentence, in plain words
The state must take the file as proof of death. It is treated as fact, not a hint.
What this is about
The person must then be taken off the rolls. Payments for them must stop. Bills for care given before the death may still be paid.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State shall immediately re-enroll such individual under the State plan (or waiver of such plan), retroactive to the date of such disenrollment.”
The section requires the State, where it finds someone was wrongly identified as dead and removed on that basis, to re-enroll that person at once, backdated to the day of removal. Nothing in the subsection stops a State using other electronic data sources to spot potentially deceased people, so long as it also meets these requirements and the rest of the eligibility rules.
What the document actually says
“the State shall immediately re-enroll such individual under the State plan (or waiver of such plan), retroactive to the date of such disenrollment.”
That sentence, in plain words
The state must put the person back on the rolls. It must do so at once. Cover runs back to the day they were taken off.
What this is about
So no gap is left in the person's cover. The state may still use other data sources. It must meet these rules as well.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: require the State to comply with the new verification rules, require quarterly screening against the Death Master File, require disenrollment and an end to payments, require reinstatement where someone was wrongly removed, and preserve the State's use of other data sources.
The punctuation edits that make room for the new paragraph.
The section works by amending section 1902 of the Social Security Act and points to section 203(d) of the Bipartisan Budget Act of 2013, neither of which is indexed here.
