HB331 Alabama 2018 Session

Summary

Primary Sponsor

Arnold MooneyRepresentative

Republican

Session

Regular Session 2018

Title

Medicaid, eligibility verification requirements required, referral of fraud for prosecution, agency required to implement work requirements, exceptions

Summary

HB 331 would require stricter Medicaid eligibility verification, allow third-party data checks, require semi-annual reviews, create fraud controls, and pursue work requirements for able-bodied enrollees.

What This Bill Does

It requires the Alabama Medicaid Agency to verify applicant eligibility before enrollment and again at least semi-annually, using data such as income, residency, immigration status, and other related factors. It allows the agency to contract with independent vendors to provide verification data, with savings expected to exceed contract costs, and requires memoranda of understanding with other agencies. It establishes procedures for handling discrepancies, including notices, opportunities to respond, and possible loss of benefits if there is noncooperation or unresolved issues. It also requires fraud referrals to district attorneys, annual reporting on verification effectiveness and savings, and the submission of a state plan amendment or waiver to implement work requirements for the able-bodied population, subject to CMS approval.

Who It Affects

• Medicaid applicants and current recipients who would be subject to enhanced eligibility checks and potential changes to their eligibility or benefits if discrepancies are found.
• The Alabama Medicaid Agency, third-party data vendors, district attorneys, and state lawmakers who would implement verification efforts, manage vendor contracts, handle fraud referrals, oversee reporting, and develop work‑requirement plans (with CMS approval).

Key Provisions

• Pre-enrollment eligibility verification required for all applicants, including income, employment, immigration, residency, enrollment in other public programs, resources, incarceration, death records, and identity-related data, subject to CMS approval.
• Agency may contract with independent vendors to provide verification data; contracts (except federal-mandated ones) must have annual savings that exceed total annual contract cost; MOUs with other agencies required.
• Semi-annual eligibility verification after enrollment, with similar data checks and possibility of contracting for additional information; agency may explore multi-state cooperation and the National Accuracy Clearinghouse.
• Discrepancy handling procedures: notice with details, opportunity to respond, documentation requirements, and potential discontinuation only after due process; reinvestigation if disputed; final written notice of action.
• Fraud referrals: suspected fraud must be referred to the appropriate district attorney for civil or criminal prosecution; agency reports to Governor, Legislature, and Department of Finance detailing effectiveness and findings.
• Work requirements: agency must submit a state plan amendment or waiver to implement work requirements for the able-bodied Medicaid population, seeking CMS approval of the firmest reasonable requirements.
• Rulemaking authority granted to the agency to implement and administer the act.
• Effective date: first day of the third month after passage and Governor approval.

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