14. Department of Health and Human Services · Notable
Tighten Medicaid eligibility determinations and asset tests
Printed page 467 14. Department of Health and Human Services
“To this end, CMS should: a. Hold states accountable for improper eligibility determinations. b. Require more robust eligibility determinations. c. Strengthen asset test determinations within Medicaid.”
What has happened
- Partially done
All three limbs were enacted, by Congress rather than by CMS. (a) States held accountable: § 71106 extends the erroneous-excess-payment penalty to payments made for ineligible individuals and to payments where eligibility cannot be confirmed, and caps the Secretary's waiver of it. (b) More robust determinations: § 71107 requires six-month redeterminations for expansion adults from the first quarter after 2026-12-31, with $75 million to implement it; §§ 71103–71105 add duplicate-enrollment screening and require removal of deceased enrollees and deceased providers. (c) Asset tests: § 71108 confines the higher home-equity limit for long-term-care eligibility to homes on agriculturally zoned lots. `partial` rather than `done` because the requirements bite between 2027 and 2030 and CMS has published no implementing regulation. The § 71107 guidance, which an earlier pass recorded as unreadable, was read in full on 2026-09-03: **SMD #26-001**, *Implementation of 'Eligibility Redeterminations,' Section 71107 of the 'Working Families Tax Cut' Legislation (Public Law 119-21)*, issued 2026-03-06 from CMCS to State Medicaid Directors, describing the amendment of section 1902(e)(14) of the Social Security Act to require the 50 states and the District of Columbia to complete redeterminations "once every six months, beginning with renewals scheduled on or after January 1, 2027" for most adult-group enrollees, including those covered through a section 1115 demonstration. An overview slide deck followed on 2026-04-03. It does not lift the rung: § 71107 does not bite until 2027-01-01, and CMS's own Working Families Tax Cut hub says CMCS "also plans to undertake rulemaking as required under the law or as otherwise warranted" — no implementing regulation yet. Guidance implementing an enacted statute that has not taken effect is the textbook `partial`.
- CMCS SMD #26-001: Implementation of 'Eligibility Redeterminations,' Section 71107 of Public Law 119-21 — six-month redeterminations for the Medicaid adult group beginning with renewals scheduled on or after January 1, 2027
- Public Law 119-21, §§ 71103–71108 (duplicate enrollment, deceased enrollees and providers, erroneous excess payments, eligibility redeterminations, home equity limit)
Research log
What was searched, and what didn’t count as evidence
Research notes
- The enrolled text of §§ 71103–71108 was read at https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm.
- Public Law 119-21 §§ 71101 and 71102 also impose moratoria on the two Biden eligibility and enrollment streamlining rules until 2035, which is the other half of “tighten”: they stop the rules that loosened determinations. Noted rather than cited separately.
- medicaid.gov was once recorded as closed to us. It is not. SMD #26-001 was fetched and read on 2026-09-03 and is now Evidence above.
- Leveling: a reviewer applying the #1281 test (statute plus implementing regulation → done) would hold this at partial for the same reason recorded here; a reviewer who reads the ask as satisfied by enactment alone would make it done. We note it as a close call.
- Action
- restrict
- Object
- Medicaid eligibility standards
- ID
- 1278