Public Assistance Verification Enhancements.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 640

Short Title: Public Assistance Verification Enhancements. (Public)
Sponsors: Representative Stevens.
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Judiciary 2, if favorable, Health, if favorable, Rules, Calendar, and Operations of
the House
April 2, 2025
*H640-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO ENHANCE VERIFICATION OF PUBLIC ASSISTANCE PROGRAMS. 2
The General Assembly of North Carolina enacts: 3
SECTION 1. G.S. 108A-55.5 reads as rewritten: 4
"§ 108A-55.5. Eligibility monitoring for medical public assistance. 5
(a) On at least a quarterly basis, the Department shall review information concerning 6
changes in circumstances that may affect medical assistance beneficiaries' eligibility to receive 7
medical assistance benefits. The Department shall share the information directl y with, or make 8
the information available to, the county department of social services that determined the 9
beneficiary's eligibility. An individual may not be considered homeless to grant a work 10
requirement exemption until and unless the Department (i) verifies that an individual has resided 11
in a public shelter for a period of at least 30 days based on notarized documentation from a public 12
shelter of such fact or (ii) certifies that there is no indoor shelter available and provides notarized 13
documentation from a public housing authority that the individual is on a waiting list for benefits. 14
(a1) Definitions. – The following definitions apply in this section: 15
(1) Governmental public assistance entity. – An entity providing public 16
assistance, including the Depa rtment of Health and Human Services and 17
public housing authorities. 18
(2) Health and medical assistance programs. – The following programs: 19
a. Supplemental Nutrition Assistance Program, or food stamps. 20
b. Temporary Assistance for Needy Families and Children, also known 21
as Work First. 22
c. Medicaid. 23
(3) Homeless individual. – An individual who (i) has resided in a public shelter 24
for a period of at least 30 days or (ii) has no indoor shelter available and is on 25
the waiting list of a public housing authority for benefits. 26
(4) Public assistance. – The following programs: 27
a. Health and medical assistance. 28
b. Public housing assistance provided by a public housing authority. 29
(5) Public housing authorit y. – A housing authorit y operating within the State 30
created pursuant to G.S. 157-4. 31
(b) The information reviewed by the Department shall include all of the following: 32
(1) Earned and unearned income. 33
(2) Employment status and changes in employment. 34
General Assembly Of North Carolina Session 2025
Page 2 House Bill 640-First Edition
(3) Residency status. 1
(4) Enrollment status in other State-administered public assistance programs. 2
(5) Financial resources. 3
(6) Incarceration status. 4
(7) Death records. 5
(8) Lottery winnings. 6
(9) Enrollment status in public assistance programs outside of this State. 7
(b1) Supplemental Nutrition Assistance Program, Temporary Assistance for Needy 8
Families and Children, Medicaid. – Governmental public assistance entities shall take the steps 9
with respect to the sources listed in this subsection as follows: 10
(1) With respect to State databases: 11
a. On at least a monthly basis, the Department of Health and Human 12
Services shall enter into a data matching agreement with the North 13
Carolina State Lottery Commission to identify households with 14
winnings of three thousand dollars ( $3,000) or more from the lo ttery 15
or from gambling and, to the extent permissible under federal law, treat 16
this data as verified upon receipt. To the extent the data may not be 17
verified upon receipt, the Department shall make referrals for further 18
investigation to identify households with winnings equal to or greater 19
than the resource limit for elderly or disabled households as defined in 20
7 C.F.R. § 273.8(b). 21
b. On at least a monthly basis, the Department of Health and Human 22
Services shall receive and review information from the North Carolina 23
Office of Vital Records concerning individuals in households enrolled 24
in health and medical assistance programs that indicates a change in 25
circumstances that may affect eligibility for these programs. 26
c. On at least a quarterly basis, the Departm ent of Health and Human 27
Services shall receive and review information from the Department of 28
Labor concerning individuals in households enrolled in health and 29
medical assistance programs that indicates a change in circumstances 30
that may affect eligibility for these programs, including , but not 31
limited to, changes in employment or wages. 32
d. On at least a monthly basis, the Department of Health and Human 33
Services shall receive and review information concerning individuals 34
in households enrolled in health and medical assistance programs that 35
indicates a change in circumstances that may affect eligibility for these 36
programs, including, but not limited to, potential changes in residency 37
as identified by out -of-state electronic benefit transfer (EBT) card 38
transactions. 39
e. On at least a quarterly basis, the Department of Health and Human 40
Services shall receive and review information from the Department of 41
Revenue concerning individuals in households enrolled in health and 42
medical assistance programs that indicates a change in circumstances 43
that may affect eligibility for these programs, including , but not 44
limited to , potential changes in income, wages, or residency as 45
identified by tax records. 46
f. On at least a monthly basis, the Department of Health and Human 47
Services shall receive and review information from the Department of 48
Adult Correction concerning individuals in households enrolled in 49
health and medical assistance programs that indicates a change in 50
circumstances that may affect eligibility for either program. 51
General Assembly Of North Carolina Session 2025
House Bill 640-First Edition Page 3
g. On at least a semimonthly basis, the Department of Health and Human 1
Services shall receive and review information from the Department of 2
Commerce concerning individuals in households enrolled in health 3
and medical assistance programs that indicates a change in 4
circumstances that may affect eligibility for these programs, including, 5
but not limited to, potential changes in employment, income, or assets. 6
(2) With respect to federal databases, on at least a monthly basis, the Department 7
of Health and Human Services shall review and act on findings affecting 8
eligibility for health and medical assistance programs with respect to the 9
following: 10
a. Earned income information, death register information, incarceration 11
records, supplemental securit y income information, beneficiary 12
records, earnings information, and pension information maintained by 13
the United States Social Security Administration. 14
b. Income and employment information maintained in the National 15
Directory of New Hires database and chi ld support enforcement data 16
maintained by the United States Department of Health and Human 17
Services. 18
c. Payment and earnings information maintained by the United States 19
Department of Housing and Urban Development. 20
d. National fleeing felon information main tained by the United States 21
Federal Bureau of Investigation. 22
(3) With respect to a nnual retail site inspections , the Department of Health and 23
Human Services shall, with all necessary coordination with appropriate 24
federal and State law enforcement authorities, conduct an on -site inspection 25
of retailers that accept EBT card transactions to identify suspicious transaction 26
records or amounts indicating possible trafficking of benefits or other criminal 27
conduct and make referrals for proper investigations under applicable law. 28
(b2) Public Posting. – On at least a quarterly basis, the Department of Health and Human 29
Services shall make available to the public on its website data from findings of noncompliance 30
and fraud investigations in health and medical assistance programs for the following aggregate 31
and nonconfidential and nonpersonal identifying information: 32
(1) The number of households investigated for intentional program violations or 33
fraud. 34
(2) The total number of households referred to the Attorney General's office for 35
prosecution. 36
(3) The total amount of improper payments and expenditures. 37
(4) The total amount of monies recovered. 38
(5) Aggregate data concerning improper payments and ineligible recipients as a 39
percentage of those investigated and reviewed. 40
(6) The aggregate amount of funds expended by electronic benefit transfer card 41
transactions in each state outside of North Carolina. 42
(b3) Medicaid Application. – Unless required under federal law, the Department may not 43
accept self-attestation of income, residency, age, household composition, caretaker or relative 44
status, or receipt of other coverage without verification prior to enrollment or renewal of or in 45
Medicaid. In addition, t he Department may not request authority to waive or decline to 46
periodically check any available income-related data sources to verify eligibility. 47
Unless required under federal law, the Department shall verify all conditions of eligibility for 48
Medicaid prior to enrollment and may not conduct post-enrollment verification without specific 49
authorization set forth in enactments by the General Assembly. 50
General Assembly Of North Carolina Session 2025
Page 4 House Bill 640-First Edition
(b4) Public Housing. – Governmental public assistance entities shall take the steps with 1
respect to the sources listed in this subsection as follows: 2
(1) With respect to State databases: 3
a. On at least a monthly basis, public housing authorities shall enter into 4
a data matching agreement with the North Carolina State Lottery 5
Commission identifying individuals in households with lottery or 6
gambling winnings of three thousand dollars ($3,000) or more. 7
b. On at least a monthly basis, public housing authorities shall receive 8
and review information from the North Carolina Office of Vital 9
Records concerning individuals in households which receive housing 10
assistance that indicates a ch ange in circumstances that may affect 11
eligibility for housing assistance , including, but not limited to, death 12
records. 13
c. On at least a quarterly basis, public housing authorities shall receive 14
and review information from the Department of Labor concerning 15
individuals in households which receive housing assistance that 16
indicates a change in circumstances that may affect eligibility for 17
housing assistance, including , but not limited to , changes in 18
employment or wages. 19
d. On at least a monthly basis , public housing authorities shall receive 20
and review information from the Department of Health and Human 21
Services concerning individuals in households which receive housing 22
assistance that indicates a change in circumstances that may affect 23
eligibility fo r housing assistance, including , but not limited to , 24
potential changes in residency as identified by out -of-state electronic 25
benefit transfer (EBT) card transactions. 26
e. On at least a quarterly basis, public housing authorities shall receive 27
and review information from the Department of Revenue concerning 28
individuals in households which receive housing assistance that 29
indicates a change in circumstances that may affect eligibility for 30
housing assistance, including, but not limited to, potential changes in 31
income, wages, or residency as identified by tax records. 32
f. On at least a monthly basis, public housing authorities shall receive 33
and review information from the Department of Adult Correction 34
concerning individuals in households whi ch receive housing 35
assistance that indicates a change in circumstances that may affect 36
eligibility. 37
g. On at least a semimonthly basis, public housing authorities shall 38
receive and review information from the Department of Commerce 39
concerning individuals i n households which receive housing 40
assistance that indicates a change in circumstances that may affect 41
eligibility for housing assistance, including , but not limited to , 42
potential changes in employment, income, or assets. 43
(2) With respect to federal databases, on at least a monthly basis, public housing 44
authorities shall review and act on findings affecting eligibility for public 45
housing assistance programs with respect to the information listed in 46
subdivision (b1)(2) of this section. 47
(3) At least once per year, each public housing authority shall submit a report to 48
the Attorney General detailing its child support cooperation requirement. Each 49
report must contain all of the following: 50
General Assembly Of North Carolina Session 2025
House Bill 640-First Edition Page 5
a. A list of departments the public housing authority has data sharing 1
agreements with. 2
b. A summary of the data received at each time interval required by this 3
subsection. 4
c. The number of individuals flagged for eligibility issues during each 5
quarterly or monthly review of the data. 6
d. The number of individuals removed from public housing assistance as 7
a result of issues flagged during the data review. 8
(4) The Attorney General shall determine and enforce compliance with the 9
provisions of this section . Any public housing authority that does not 10
implement the data checks required by this section shall be deemed to be out 11
of compliance with the requirements of this section. The Attorney General 12
shall publish an annual report detailing each public housing authority 's 13
compliance from the previous year. The first instance in which t he Attorney 14
General finds that a public housing authority is out of compliance with this 15
section, the public housing authority shall submit a corrective action plan to 16
implement the requirements under this section within 12 months. A second 17
finding of nonc ompliance that occurs more than eight years after the first 18
finding of noncompliance shall be treated as the first finding of 19
noncompliance. The second instance in which the Attorney General finds that 20
a public housing authority is out of compliance with t his section, the public 21
housing authority shall have its charter under Chapter 157 of the General 22
Statutes revoked and cease to operate in this State. 23
(c) A county department of social services The Department of Health and Human 24
Services and public housing authorities shall promptly review the information provided or made 25
available by the Department in accordance with subsection (a) subsections (a) through (b4) of 26
this section to determine if the information indicates a change in circumstances that may affect a 27
medical public assistance beneficiary's eligibility to receive medical public assistance benefits 28
and take one of the following actions: 29
(1) If a review of the information does not result i n the county department of 30
social services Department of Health and Human Services or public housing 31
authority finding a discrepancy or change in a beneficiary's circumstances that 32
may affect that beneficiary's eligibility to receive medical public assistance 33
benefits, the county department of social services Department of Health and 34
Human Services or public housing authority shall take no further action. 35
(2) If a review of the information does result in the county department of social 36
services Department of Health and Human Services or public housing 37
authority finding a discrepancy or change in a beneficiary's circumstances that 38
may affect that beneficiary's eligibility for medical public assistance benefits, 39
the county department of social services Department of Health and Human 40
Services or public housing authority shall provide written notice to the 41
beneficiary that describes in sufficient detail the circumstances of the 42
discrepancy or change in circumstances that would affect the beneficiary's 43
eligibility for medical public assistance benefits. The notice must include the 44
following information: 45
a. The beneficiary will have 12 calendar days from the time of mailing 46
to respond. 47
b. A response from the beneficiary must be in writing. 48
c. Self-declarations made by the beneficiary will not be accepted as 49
verification of information in the response. 50
d. The consequences of taking no action. 51
General Assembly Of North Carolina Session 2025
Page 6 House Bill 640-First Edition
(d) After the expiration of 12 calendar days from the time of mailing the notice required 1
under subsection (c) of this s ection, the county department of social services Department of 2
Health and Human Services or public housing authority shall take one of the following 3
actions:actions within 60 days of receiving the public assistance beneficiary 's written 4
disagreement: 5
(1) If a beneficiary did not respond to the notice, the county department of social 6
services Department of Health and Human Services or public housing 7
authority shall redetermine the beneficiary's eligibility for medical public 8
assistance benefits and provide the beneficiary with proper notice under 9
G.S. 108A-79. 10
(2) If a beneficiary responds to the notice and disagrees with the information in 11
the notice, the county department of social services Department of Health and 12
Human Services or public housing authority shall reinvestigate the matter and 13
take one of the following actions: 14
a. If the county department of social services Department of Health and 15
Human Services or public housing authority determines that there has 16
been an error and the beneficiary's eligibility to receive medical public 17
assistance benefits is not affected, then no further action shall be taken. 18
b. If the county department of social services Department of Health and 19
Human Services or public housing authority determines that there is 20
no error, the county department of social services Department of 21
Health and Human Services or public housing authority shall 22
redetermine the beneficiary's eligibility for medical public assistance 23
benefits and provide the beneficiary with proper notice under 24
G.S. 108A-79. 25
(3) If a beneficiary responds to the notice and confirms the information in the 26
notice is correct, then the county department of social services Department of 27
Health and Human Services or public housing authority shall redetermine the 28
beneficiary's eligibility for medical public assistance benefits and provide the 29
beneficiary with proper notice under G.S. 108A-79. 30
If, at any time after receiving a beneficiary's response to the notice, the county department of 31
social services Department of Health and Human Services or public housing authority determines 32
that there is a risk of fraud or misrepresentation or inadequate documentation, then the county 33
department of social services may request additional documentation from the beneficiary. 34
(e) Nothing in this section shall preclude the Department or any county department of 35
social services public housing authority from receiving or reviewing additional information 36
related to a beneficiary's eligibility for medical public assistance benefits that is obtained in a 37
manner other than that provided for under this section. 38
(f) The Department of Health and Human Services and public housing authorities shall 39
have the authority to execute a memorandum of understanding with any department, agency, or 40
division for information required to be shared between agencies outlined in this section. 41
(g) Nothing in this section shall prohibit the D epartment of Health and Human Services 42
or a public housing authority from contracting with one or more independent vendors to provide 43
additional data or information which may indicate a change in circumstances that may affect 44
eligibility. 45
(h) The Departmen t of Health and Human Services shall promulgate all rules and 46
regulations necessary for the purposes of carrying out this section." 47
SECTION 2. This act becomes effective January 1, 2026. 48