SB195 Alabama 2017 Session

Summary

Primary Sponsor

Arthur OrrSenator

Republican

Session

Regular Session 2017

Title

Medicaid Agency, eligibility verification mechanisms required, identity verification, use of third-party vendors auth., reporting of fraud

Summary

The bill would require Alabama Medicaid to verify eligibility and identity, use third-party data sources, and report on anti-fraud results, with quarterly checks and enforcement procedures.

What This Bill Does

Before awarding benefits, it would verify a wide range of applicant information (income, employment, residency, immigration status, other public programs, resources, etc.). It would allow contracting with independent vendors if the expected savings exceed costs. After enrollment, it would require quarterly eligibility checks and identity verification, and establish dispute procedures for findings that may affect eligibility. It would refer suspected fraud to the Attorney General or district attorney and require regular reporting on the program’s effectiveness and any savings.

Who It Affects

• Medicaid applicants and enrollees: subject to expanded verification and potential changes or loss of benefits if discrepancies are found, with opportunities to explain and resolve findings.
• Alabama Medicaid Agency and its contractors, including third-party vendors: responsible for conducting verifications, processing disputes, coordinating with other state agencies, and reporting results.

Key Provisions

• Section 1 requires verification of eligibility information before enrollment and authorizes contracting with independent vendors for data such as income, employment, immigration, residency, other public assistance enrollment, resources, incarceration, death records, enrollment outside the state, and identity fraud.
• Section 1 also requires memoranda of understanding with other state departments for sharing data and requires that vendor contracts produce annual savings exceeding costs.
• Section 2 requires quarterly eligibility reviews after initial enrollment, outlines data to review, allows contracting with vendors, and requires the agency to join multi-state cooperatives like the National Accuracy Clearinghouse; it sets a step-by-step process for discrepancies and redeterminations and timelines for responses.
• Section 3 requires identity authentication using a knowledge-based exam, available online, in-person, or by phone, and designed to accommodate applicants with limited credit history.
• Section 4 requires the agency to refer suspected fraud to the Attorney General or district attorney.
• Section 5 requires quarterly and annual reports to the Governor, Legislature, and Department of Finance detailing effectiveness, findings, cases reviewed, closures, prosecutions, recoveries, and estimated savings.
• Section 6 gives the agency rulemaking authority to implement the act.
• Section 7 establishes the act's effective date (first day of the third month after passage).

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Medicaid