§ 20-77-2102 — Medicaid Eligibility Verification System - Definitions

(a) The Department of Human Services shall establish and maintain the Medicaid Eligibility Verification System that is designed to prevent fraud in the establishment and maintenance of Medicaid eligibility. (b) (1) In establishing the Medicaid Eligibility Verification System, the department shall be an "assessment state" and not a "determination state" for purposes of Medicaid eligibility determinations by the federally facilitated marketplace. (2) As used in this subsection: (A) "Assessment state" means a state with a federally facilitated marketplace that can elect to have the federally facilitated marketplace make assessments of Medicaid eligibility and then transfer the account of an individual to the state Medicaid agency for a final determination; and (B) "Determination state" means a state that requires the eligibility determination made by the federally facilitated marketplace to be accepted by the state Medicaid agency. (c) Notwithstanding other provisions of law, the department shall not accept Medicaid eligibility determinations from an exchange or marketplace established under 42 U.S.C. § 18041(c) before verifying eligibility independently and making a Medicaid eligibility determination.

Legislative History

Amended by Act 2021, No. 780,§ 3, eff. 7/28/2021. Amended by Act 2017EX1, No. 6,§ 8, eff. 5/4/2017. Amended by Act 2017EX1, No. 3,§ 8, eff. 5/4/2017. Added by Act 2013, No. 1265,§ 1, eff. 8/16/2013.