PRINTER'S NO. 388
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
421
Session of
2023
INTRODUCED BY HAMM, KEEFER, ROWE, ZIMMERMAN, GROVE, KAUFFMAN,
PICKETT, STAMBAUGH, FLICK, JOZWIAK, MOUL, WARNER AND JAMES,
MARCH 15, 2023
REFERRED TO COMMITTEE ON HUMAN SERVICES, MARCH 15, 2023
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
further providing for verification of eligibility.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 441.9 of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, is amended by
adding subsections to read:
Section 441.9. Verification of Eligibility.--* * *
(d) The following apply regarding lottery winnings:
(1) The department shall enter into a data matching
agreement with the Pennsylvania Gaming Control Board to identify
individuals with lottery or gambling winnings of three thousand
dollars ($3,000) or more.
(2) On at least a monthly basis, the department shall review
the information under paragraph (1) and close the case for
individuals who are ineligible for medical assistance based upon
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verification of the winnings specified under paragraph (1).
(3) An individual who has failed to disclose the winnings
specified under paragraph (1) and has been identified through
the database match shall be deemed to have presumptively
committed an intentional violation of the medical assistance
program.
(e) On at least a monthly basis, the department shall
receive and review information from the Department of Health
concerning individuals enrolled in medical assistance that
indicates a change in circumstances that may affect eligibility
for medical assistance, including death records.
(f) On at least a quarterly basis, the department shall
receive and review information from the Department of Labor and
Industry concerning individuals enrolled in medical assistance
that indicates a change in circumstances that may affect
eligibility for medical assistance, including changes in
employment or wages.
(g) On at least a monthly basis, the department shall review
information concerning individuals enrolled in medical
assistance that indicates a change in circumstances that may
affect eligibility for medical assistance, including potential
changes in residency as identified by out-of-State electronic
benefit transfer (EBT) transactions.
(h) On at least a monthly basis, the department shall
receive and review information from the Department of
Corrections concerning individuals enrolled in medical
assistance that indicates a change in circumstances that may
affect eligibility for medical assistance.
(i) On at least a quarterly basis, the department shall
receive and review information from the Department of Revenue
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concerning individuals enrolled in medical assistance that
indicates a change in circumstances that may affect eligibility
for food stamps, including potential changes in income, wages or
residency as identified by tax records.
(j) Notwithstanding any other provision of law, the
department shall not accept eligibility determinations for
medical assistance from a health insurance exchange established
in this Commonwealth u nder 42 U.S.C. ยง 18041(c) (relating to
State flexibility in operation and enforcement of Exchanges and
related requirements) . The department may accept assessments
from the exchange but shall verify eligibility and make
eligibility determinations.
(k) If the department receives information concerning an
individual enrolled in medical assistance that indicates a
change in circumstances that may affect eligibility for medical
assistance, the department shall review the individual's case.
(l) The department may execute a memorandum of understanding
with any other State department, agency or division for
information required to be shared between entities specified in
this section.
(m) Nothing in this section shall prohibit the department
from contracting with one or more independent vendors to provide
additional data or information that may indicate a change in
circumstances that may affect eligibility for medical
assistance.
(n) Unless required under Federal law, the department may
not:
(1) Designate itself as a qualified health entity for the
purpose of making presumptive eligibility determinations or for
any purpose not expressly authorized by State law.
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(2) Accept self-attestation of income, residency, age,
household composition, caretaker or relative status or receipt
of other coverage without verification prior to enrollment.
(3) Request authority to waive or decline to periodically
check any available income-related data sources to verify
eligibility.
(4) Request authority to waive or decline to comply with
public notice requirements applicable to proposed changes to the
State plan in accordance with 42 CFR 440.386 (relating to public
notice), 447.205 (relating to public notice of changes in
Statewide methods and standards for setting payment rates) and
447.57 (relating to beneficiary and public notice requirements).
Section 2. This act shall take effect in 60 days.
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