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Requires states and the District of Columbia to run automated quarterly checks of the federal Death Master File (DMF) starting January 1, 2027, to identify Medicaid enrollees who appear to be deceased. When a DMF match occurs, the state must treat that match as confirmation of death for Medicaid eligibility rules, disenroll the individual, and stop future Medicaid payments (but continue payments for services provided before death). If a match is later found to be a mistaken identification, the state must immediately reenroll the person and make coverage retroactive.
The bill aims to reduce improper Medicaid payments and modernize mortality checks, but it increases the risk of wrongful disenrollments and adds administrative and provider payment strains for states and health systems.
State governments and taxpayers will see fewer improper Medicaid payments because the program identifies deceased enrollees and stops future payments.
Low-income individuals who are wrongly matched to death records will be promptly reenrolled with retroactive coverage, protecting those patients and hospitals from gaps caused by misidentification.
State governments can use additional electronic data sources for mortality verification, giving them more flexibility and the potential for more accurate determinations of deceased status.
Low-income individuals may be erroneously disenrolled based on Death Master File matches, risking temporary loss of Medicaid coverage until reenrollment is completed.
State Medicaid agencies will face new administrative burdens and costs to build and run quarterly automated matches and correction processes, straining operations and budgets.
Hospitals and other providers could experience billing and cash-flow disruptions if Medicaid payments are stopped for enrollees incorrectly or for services provided near the time of death.
Introduced February 18, 2025 by Gus Bilirakis · Last progress February 18, 2025