LIVE Beneficiaries Act
- Sponsor
- Rep. Bilirakis, Gus M. [R-FL-12]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Feb 18, 2025
Bottom line
The bill aims to enhance Medicaid program integrity and reduce improper payments by requiring states to regularly verify that beneficiaries are not deceased, while including a safeguard for erroneous disenrollments.
What it actually does
This bill amends the Social Security Act to mandate that states and the District of Columbia conduct quarterly reviews of the Death Master File to identify deceased individuals enrolled in Medicaid. Upon identification, states must disenroll the individual and cease medical assistance payments, with a provision for retroactive re-enrollment if an individual is mistakenly identified as deceased.
Proponents argue
Supporters argue that this bill is a crucial step to prevent wasteful spending and ensure the fiscal integrity of the Medicaid program by systematically identifying and removing deceased individuals from enrollment. They contend it establishes a clear, standardized process for states to reduce improper payments and ensure taxpayer dollars are used efficiently.
Opponents contend
Opponents might express concerns about the potential for increased administrative burdens on state Medicaid agencies to implement these quarterly checks and manage disenrollments and reinstatements. They may also highlight the risk of erroneous disenrollments due to data inaccuracies in the Death Master File, which could disrupt essential healthcare for living beneficiaries.
The bill is concise and clearly written, allowing for a quick and thorough understanding of its provisions and implications.
Section 2(2), adding new subsection (uu)(1)(A) to Section 1902 of the Social Security Act
Mandatory Quarterly Death Master File Review
This provision requires the 50 States and the District of Columbia, starting January 1, 2027, to review the Death Master File (DMF) at least once every quarter. The purpose of this review is to determine if any individuals currently enrolled in their Medicaid programs (or waivers thereof) are deceased.
Supporters argue
Proponents argue this provision is essential for enhancing program integrity and fiscal responsibility within Medicaid by establishing a consistent, mandatory mechanism to identify deceased beneficiaries and prevent payments on their behalf.
Critics contend
Opponents may contend that this mandate imposes an unfunded administrative burden on states, potentially requiring significant resources for implementation and ongoing compliance, which could divert funds from direct beneficiary services.
Tradeoffs
This provision balances the federal interest in reducing improper payments against the potential for increased administrative costs and operational complexities for state Medicaid agencies.
Section 2(2), adding new subsection (uu)(1)(B) to Section 1902 of the Social Security Act
Disenrollment and Payment Cessation for Deceased Enrollees
If a state determines, based on the Death Master File, that a Medicaid enrollee is deceased, this provision mandates specific actions. The state must treat this information as factual confirmation of death, disenroll the individual from Medicaid, and immediately stop all future payments for medical assistance on their behalf. Payments for services furnished prior to the individual's death are explicitly exempted.
Section 2(2), adding new subsection (uu)(1)(C) to Section 1902 of the Social Security Act
Reinstatement for Erroneous Disenrollment
This provision establishes a safeguard: if a state determines that an individual was mistakenly identified as deceased by the Death Master File and was consequently erroneously disenrolled from Medicaid, the state must immediately re-enroll that individual. This re-enrollment must be retroactive to the original date of disenrollment, ensuring no lapse in coverage due to the error.
This 'Rule of Construction' clarifies that states are not prevented from using other electronic data sources to identify potentially deceased beneficiaries in a timely manner. However, it explicitly states that using other sources does not exempt states from complying with the mandatory quarterly Death Master File review and all other Medicaid eligibility requirements.
Section 2(2), adding new subsection (uu)(2) to Section 1902 of the Social Security Act
Why it matters:This is standard legislative practice to clarify the scope and interaction of new requirements with existing or alternative state practices, ensuring the new mandate serves as a baseline rather than an exclusive method.
Case for: Supporters argue this clause ensures that states cannot circumvent the new federal mandate by claiming they have superior or alternative systems. It guarantees a minimum standard of verification while allowing states flexibility to innovate and use additional tools for program integrity.
Case against: Critics might argue that if a state has a demonstrably more effective and frequent system for identifying deceased beneficiaries, requiring an additional quarterly DMF check could be redundant and an inefficient use of state resources.
Estimated impact: This provision ensures that all states meet a baseline standard for identifying deceased beneficiaries, potentially increasing overall compliance and reducing improper payments across the Medicaid program.