Social Services Amendments

42
26B-3-142.1
26B-3-142.2
26B-3-142.3
26B-3-142.4
26B-3-142.5
26B-3-142.6
35A-17-202
35A-17-301
35A-17-302
26B-3-142.1
26B-3-142.2
26B-3-142.3
26B-3-142.4
26B-3-142.5
26B-3-142.6
35A-17-202
35A-17-301
35A-17-302
0
Social Services Amendments
2026 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Logan J. Monson
Senate Sponsor: Keven J. Stratton
LONG TITLE
General Description:
This bill enacts provisions related to social services programs.
Highlighted Provisions:
This bill:
amends provisions related to the Medicaid program, including:
work requirements for certain Medicaid enrollees;
verification standards for the Department of Health and Human Services (DHHS);
citizenship requirements;
procedures for disenrolling individuals no longer eligible for Medicaid due to death or
state residency requirements; and
limiting retroactive eligibility;
amends provisions related to the Supplemental Nutrition Assistance Program, including
provisions related to:
work requirements; and
citizenship; and
creates reporting requirements.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides a special effective date.
Utah Code Sections Affected:
ENACTS:
26B-3-142.1
Effective
01/01/27
, Utah Code Annotated 1953
26B-3-142.2
Effective
01/01/27
, Utah Code Annotated 1953
26B-3-142.3
Effective
05/06/26
, Utah Code Annotated 1953
26B-3-142.4
Effective
01/01/27
, Utah Code Annotated 1953
26B-3-142.5
Effective
05/06/26
, Utah Code Annotated 1953
26B-3-142.6
Effective
01/01/27
, Utah Code Annotated 1953
35A-17-202
Effective
05/06/26
, Utah Code Annotated 1953
35A-17-301
Effective
05/06/26
, Utah Code Annotated 1953
35A-17-302
Effective
05/06/26
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section
26B-3-142.1
is enacted to read:
26B-3-142.1
Effective
01/01/27
. Medicaid work requirements.
(1)
As used in this section:
(a)
"Applicable individual" means an individual who:
(i)
is eligible to enroll in Medicaid under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); or
(ii)
(A)
is eligible to enroll under a waiver that provides coverage that is equivalent
to minimum essential coverage as described in 26 U.S.C. Sec. 5000A;
(B)
is at least 19 years old and younger than 65 years old;
(C)
is not pregnant;
(D)
is not entitled to, enrolled for, or eligible to enroll for, benefits under Part A of
Title XVIII of the Social Security Act; and
(E)
is not entitled to, enrolled for, or eligible to enroll for, benefits under Part B of
Title XVIII of the Social Security Act.
(b)
"Health care professional" means an individual practicing within the scope of the
individual's professional license.
(c)
"Work requirements" means the requirements established by 42 U.S.C. Sec.
1396a(xx).
(2)
The department shall implement work requirements for applicable individuals.
(3)
(a)
The department may not enroll an applicable individual in Medicaid unless, at the
time of application, the individual demonstrates compliance with the work
requirements for one month immediately preceding the month during which the
individual applies.
(b)
The department:
(i)
shall use documentary evidence, including claims data; and
(ii)
may not rely exclusively on self-attestation as evidence.
(c)
The department shall verify an applicable individual's compliance with work
requirements through state wage data, Department of Workforce Services records,
education or training program enrollment, or verified volunteer service
documentation.
(d)
The department shall verify that an applicable individual complied with work
requirements for one month during the applicable individual's current eligibility
period before completing the applicable individual's next redetermination of
eligibility.
(4)
(a)
An applicable individual seeking an exemption from work requirements shall
provide documentation for the exemption sought unless the department is able to
make the determination through other reliable sources of information.
(b)
The department:
(i)
shall verify all exemptions;
(ii)
may not accept exemption designations, approvals, or determinations by a
managed care organization; and
(iii)
may accept data provided by a managed care organization to verify or make a
determination regarding an exemption.
(c)
If the individual is attempting to obtain an exemption from the work requirements
because the individual is medically frail or otherwise an individual with special
needs, and electronic data is determined insufficient, the department may:
(i)
provisionally approve the exemption based on a diagnosis identified by the
individual; and
(ii)
shall verify the exemption using electronic data or through a statement from a
health care professional indicating the individual as:
(A)
being blind or disabled as defined in 42 U.S.C.
Sec. 1382c(2) or (3);
(B)
having a disabling mental disorder;
(C)
having a physical, intellectual, or developmental disability that significantly
impairs the individual's ability to perform one or more activities of daily living,
which may include eating, dressing, bathing, grooming, getting in and out of
bed and chairs, walking, going outdoors, or using the toilet;
(D)
having a substance use disorder;
(E)
having a serious or complex medical condition; or
(F)
experiencing homelessness.
(5)
Once work requirements are implemented, beginning August 31, 2027, and no later than
August 31 of each subsequent year, the department shall submit annual reports to the
Health and Human Services Interim Committee and the governor on compliance rates,
the number and type of exemptions granted, and the impact on Medicaid enrollment.
Section 2. Section
26B-3-142.2
is enacted to read:
26B-3-142.2
Effective
01/01/27
. Verification of eligibility.
(1)
Except as required under federal law, the department may not accept self-attestation of
any of the following in the administration of the Medicaid program without verification
before enrollment:
(a)
income;
(b)
residency;
(c)
identity; and
(d)
citizenship or immigration status.
(2)
Upon receiving information concerning an enrollee that indicates a change in
circumstances that may affect Medicaid eligibility, the department shall promptly
conduct an eligibility determination for the enrollee unless the enrollee has continuous
eligibility in accordance with state and federal law.
(3)
Except as provided in federal law, the department shall conduct an eligibility
redetermination for an
enrollee:
(a)
eligible under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII) once every six months; and
(b)
not described in Subsection
(3)(a)
once every 12
months.
Section 3. Section
26B-3-142.3
is enacted to read:
26B-3-142.3
Effective
05/06/26
. Citizenship requirements.
(1)
As used in this section, "qualified citizen" means a resident of the United States and
meets at least one of the following criteria:
(a)
a citizen or national of the United States;
(b)
an alien lawfully admitted for permanent residence as an immigrant, as defined in 8
U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists,
diplomats, students, or other individuals admitted temporarily without intent to
abandon their residence in a foreign country;
(c)
an alien who has been granted the status of Cuban or Haitian entrant, as defined in S
ection 501(e) of the Refugee Education Assistance Act of 1980;
(d)
an individual lawfully residing in the United States in accordance with a Compact of
Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G); or
(e)
a lawfully present child described in 42
U.S.C
.
Sec. 1396b(v)(4).
(2)
Beginning on October 1, 2026, the department:
(a)
unless required by federal law, may not provide medical assistance to any individual
unless that individual is a qualified citizen;
(b)
shall require that all income of ineligible household members of the applicant be
included when calculating financial eligibility for Medicaid to the extent allowed
under federal law;
(c)
shall include an immigration status on all presumptive eligibility applications
submitted to the agency;
(d)
shall require hospitals, clinics, and other qualified entities conducting presumptive
eligibility determinations to collect and transmit any attestation to the agency;
(e)
may not allow a presumptive eligibility application to be approved unless the
applicant attests that the applicant is a qualified citizen; and
(f)
shall conduct regular cross-checks of applicant and enrollee information against
federal databases, including the Systematic Alien Verification for Entitlements
program.
Section 4. Section
26B-3-142.4
is enacted to read:
26B-3-142.4
Effective
01/01/27
. Multi-state enrollment.
(1)
(a)
The department shall:
(i)
receive and review address change information from returned mail by the United
States Postal Service, the National Change of Address database, and accountable
care organizations;
(ii)
conduct cross-checks regarding all address change information against state
Medicaid enrollment to identify enrollees who have moved out of state;
(iii)
receive and review information regarding out-of-state electronic benefit
transactions; and
(iv)
conduct cross-checks of out-of-state electronic benefit transactions against state
Medicaid enrollment to identify enrollees who have moved out of state.
(b)
Upon receiving information concerning an enrollee that indicates a change in
circumstances that may affect Medicaid eligibility, including a change in residency,
the department shall promptly conduct an eligibility determination for the recipient.
(2)
Beginning no later than October 1, 2029, the department shall submit enrollment
information to CMS's national Medicaid enrollment database every month to identify
individuals enrolled in Medicaid in multiple states at the same time.
(3)
(a)
Beginning August 31, 2028, and no later than August 31 of each subsequent year,
the department shall submit an annual report to the Health and Human Services
Interim Committee detailing the implementation of the requirements established in
this section.
(b)
The report shall include for the prior fiscal year:
(i)
the number of enrollees flagged through address change information and
out-of-state electronic benefit transactions;
(ii)
the number of enrollees disenrolled from the Medicaid program due to enrollment
in multiple states; and
(iii)
the estimated fiscal impact to the state due to implementing the requirements of
this section.
Section 5. Section
26B-3-142.5
is enacted to read:
26B-3-142.5
Effective
05/06/26
. Remove deceased enrollees.
(1)
As used in this section, "death master file" means the database maintained by the Social
Security Administration that contains reported deaths.
(2)
The department shall:
(a)
receive and review information from the death master file;
(b)
conduct cross-checks between information obtained from the death master file and
state Medicaid enrollment at least each quarter to identify deceased enrollees;
(c)
receive and review information regarding birth and death records from the Office of
Vital Records and Statistics;
(d)
remove any identified deceased enrollee from the Medicaid program promptly upon
confirmation of death;
(e)
ensure that no Medicaid payments are made on behalf of a deceased enrollee for
services rendered after the date of death; and
(f)
recoup any funds expended on deceased enrollees for capitations or services
occurring after the date of death.
(3)
The Office of Inspector General of Medicaid Services, created in Section
63A-13-201
,
shall conduct periodic reviews to ensure compliance with these requirements.
Section 6. Section
26B-3-142.6
is enacted to read:
26B-3-142.6
Effective
01/01/27
. Retroactive eligibility.
(1)
As used in this section:
(a)
"Expansion population" means the population who is enrolled in the Medicaid
program under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII).
(b)
"Traditional population" means the population who is enrolled in Medicaid under a
provision of federal law that is not 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII),
including pregnant women, children, elderly individuals, and individuals with
disabilities.
(c)
"Retroactive eligibility" means Medicaid coverage for services provided before the
month of application, as authorized by 42 U.S.C. Sec. 1396(a)(34).
(2)
(a)
The department shall limit retroactive eligibility for Medicaid benefits as follows:
(i)
for the expansion population, Medicaid coverage may be made retroactive for no
more than one month before the month in which the enrollee submits a completed
Medicaid application; and
(ii)
for the traditional population, Medicaid coverage may be made retroactive for no
more than two months before the month in which the individual submits a
completed Medicaid application.
(b)
The limitations described in Subsection
(2)(a)
apply only to initial applications for
Medicaid and do not affect eligibility for continuous or ongoing coverage.
(3)
(a)
In accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking
Act,
the department shall make rules necessary to implement and enforce the provisions of
this section.
(b)
The department may establish procedures to notify applicants and providers of
changes in eligibility policy, and shall ensure compliance with all federal
requirements regarding notice and due process.
(4)
(a)
Beginning on August 31, 2027, and no later than August 31 of each subsequent
year, the department shall submit an annual report to the Health and Human Services
Interim Committee detailing the implementation and impact of the retroactive
benefits limitation established in Subsection
(2)
.
(b)
The report shall include for the prior fiscal year:
(i)
the number of Medicaid applications processed for the expansion population and
the number of applications processed for the traditional population;
and
(ii)
the estimated savings to the state created due to the benefits limitation established
in Subsection
(2)
.
Section 7. Section
35A-17-202
is enacted to read:
17. SNAP Benefits
2. Work Requirements
35A-17-202
Effective
05/06/26
. Approval of work requirement waiver request.
The department may not submit a waiver for a work requirement in accordance with 7
U.S.C. Sec. 2015(o)(4) unless the waiver is approved by the Legislature and governor by
concurrent resolution.
Section 8. Section
35A-17-301
is enacted to read:
3. Citizenship
35A-17-301
Effective
05/06/26
. Inclusion of financial resources.
(1)
The department shall determine an individual's eligibility for SNAP benefits in
accordance with 7 U.S.C. Ch. 51, Supplemental Nutrition Assistance Program.
(2)
Notwithstanding 7 C.F.R. Sec.

273.11(c)(3) and if approved by the United States
Department of Agriculture, the department may not prorate or exclude the income,
deductions, or financial resources of ineligible aliens in determining the eligibility and
the value of the allotment of the household of which the individual is a member.
Section 9. Section
35A-17-302
is enacted to read:
35A-17-302
Effective
05/06/26
. Citizenship requirements.
(1)
In accordance with 7 U.S.C. Sec. 2015(f), an individual may not participate in SNAP
benefits unless the individual:
(a)
is a resident of the United States; and
(b)
meets at least one of the following criteria:
(i)
is a citizen or national of the United States;
(ii)
is an alien lawfully admitted for permanent residence as an immigrant, as defined
in 8 U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists,
diplomats, students, or other individuals admitted temporarily without intent to
abandon their residence in a foreign country;
(iii)
is an alien who has been granted the status of Cuban or Haitian entrant, as
defined in S
ection 501(e) of the Refugee Education Assistance Act of 1980; or
(iv)
is an individual lawfully residing in the United States in accordance with a
Compact of Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G).
(2)
The department shall require an individual to provide documentary proof of citizenship
or immigration status to determine eligibility.
(3)
Acceptable forms of documentary evidence of an individual's citizenship or alien status
include:
(a)
birth or hospital records;
(b)
voter registration cards;
(c)
United States passports;
(d)
United States Citizenship and Immigration Service documentation; or
(e)
electronically available data.
(4)
If an individual is unable to provide the documentation described in Subsection
(3)
, the d
epartment shall verify the individual's alien status using the Systematic Alien
Verification for Entitlements

online
service during enrollment and eligibility
recertification.
Section 10.
Effective Date.
(1)
Except as provided in Subsection (2), this bill takes effect
May 6, 2026
.
(2)
The actions affecting the following sections take effect on
January 1, 2027
:
(a)
Section 26B-3-142.1
Effective
01/01/27
;
(b)
Section 26B-3-142.2
Effective
01/01/27
;
(c)
Section 26B-3-142.4
Effective
01/01/27
; and
(d)
Section 26B-3-142.6
Effective
01/01/27
.
3-6-26 10:42 PM