§ 46:440.21 — Medicaid program integrity measures

Louisiana § 46:440.21

• Jurisdiction: Louisiana
• Title 46: Public Welfare and Assistance

Text

§440.21. Medicaid program integrity measures
A. The legislature hereby finds and declares the following:
(1) It is the policy of this state to protect public benefits for those who are truly needy
and eligible for such benefits and to prevent waste and fraud from limiting available
resources and increasing dependency unnecessarily.
(2) The Medicaid program provides support to needy households and persons.
(3) It is the intent of this Subpart to institute a system of modern and comprehensive
interagency data cross-checks and to implement other program integrity measures available
to ensure ongoing eligibility for Medicaid and to limit the use of ex parte renewals to the
extent allowed.
B. The Louisiana Department of Health shall adopt the following measures to verify
ongoing eligibility for Medicaid:
(1) The Louisiana Department of Health shall not accept eligibility determinations
for Medicaid from any exchange established under 42 U.S.C. 18041(c). The Louisiana
Department of Health may accept assessments from an exchange established under 42 U.S.C.
18041(c), but shall independently verify eligibility and make eligibility determinations.
(2) Neither the Louisiana Department of Health nor any state agency that operates
as a part of Medicaid may rely solely on ex parte renewals, including but not limited to any
waiver granted under Section 1902(e)(14)(A) of the Social Security Act, unless expressly
required by federal law. No later than January 1, 2026, the Louisiana Department of Health
shall withdraw any waivers submitted to the federal government that authorize the
department to determine or renew eligibility by ex parte renewal.
(3) Unless required by federal law, the Louisiana Department of Health shall not
accept self-attestation of Louisiana state residency for initial eligibility determinations or
renewals. The Louisiana Department of Health may use technology and government data
sharing to verify income, residency, household composition, or receipt of other coverage. The
Louisiana Department of Health shall not request authority to waive or decline to periodically
check any available income-related data sources to verify eligibility for Medicaid.
(4) The Louisiana Department of Health may use an enhanced income verification
platform to verify recipient eligibility. The Louisiana Department of Health may procure and
enter into a contract for the platform. The platform shall meet all of the following criteria:
(a) Use automated, real-time data matching and analytics to detect unreported or
under reported income.
(b) Consolidate overlapping data to prevent double counting of financial records.
(5) The Louisiana Department of Health shall enter into the following data matching
agreements to cross-check households enrolled in Medicaid with other state data sets as
allowed by law:
(a) On at least a monthly basis, the Louisiana Department of Health shall receive and
review information from the state registrar of vital records concerning individuals enrolled
in Medicaid that indicates a change in circumstances that may affect eligibility for Medicaid,
including but not limited to death records.
(b) On at least a quarterly basis, the Louisiana Department of Health shall receive
and review information from Louisiana Works concerning individuals enrolled in Medicaid
that indicates a change in circumstances that may affect eligibility for Medicaid, including
but not limited to changes in employment or wages.
(c) On at least a quarterly basis, the Louisiana Department of Health shall receive
and review information from the Department of Public Safety and Corrections, office of
motor vehicles concerning individuals enrolled in Medicaid that indicates a change in
residency that may affect eligibility for Medicaid.
(d) On at least a semi-annual basis, the Louisiana Department of Health shall receive
and review information from the Louisiana Department of Revenue concerning individuals
enrolled in Medicaid that indicates a change in circumstances that may affect eligibility for
Medicaid, including but not limited to potential changes in income, wages, or residency as
identified by tax records.
(e) The Louisiana Department of Health shall implement a platform to receive and
review information on at least an annual basis concerning incarceration status of individuals
enrolled in Medicaid.
(f) On at least a monthly basis, the Louisiana Department of Health shall receive and
review information from the Social Security Administration concerning the disability status
of individuals enrolled in Medicaid.
(6) On at least a quarterly basis, the Louisiana Department of Health shall publish
on its website, data regarding findings of noncompliance and fraud investigations in
Medicaid for the following aggregate, nonconfidential, and nonpersonally identifying
information:
(a) The number of Medicaid cases investigated for intentional program violations or
fraud.
(b) Total number of Medicaid cases referred to the attorney general's office for
prosecution.
(c) Improper payments and expenditures.
(d) Monies recovered.
(e) Aggregate data concerning improper payments and ineligible recipients as a
percentage of those investigated and reviewed.

Legislative History

Acts 2025, No. 427, §1, eff. June 20, 2025.