HR-1403-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Gus Bilirakis (R-FL)
What it does
This bill would amend title XIX of the Social Security Act to require all 50 states and the District of Columbia to check the federal Death Master File at least once every quarter to identify and disenroll deceased Medicaid beneficiaries, beginning January 1, 2027. If a state finds that an enrolled individual has died, it would be required to stop payments on their behalf. The bill also includes an error-correction provision: if a living person is mistakenly identified as deceased and disenrolled, the state must immediately reinstate their coverage retroactively to the date of the erroneous disenrollment.
Who benefits
Federal and state taxpayers who fund Medicaid, as improper payments to deceased enrollees would be reduced. State Medicaid agencies that currently lack a uniform federal standard for this type of verification would receive clear compliance guidance. Legitimate Medicaid enrollees broadly, to the extent that reduced improper payments preserve program funding. Data integrity and program oversight advocates. Congressional budget offices and auditors seeking measurable accountability in entitlement spending.
Who is hurt
Living individuals who are incorrectly flagged as deceased by the Death Master File — a known data quality problem — and who could face a gap in Medicaid coverage before reinstatement, potentially disrupting access to medications, scheduled procedures, or ongoing care. Vulnerable populations such as elderly, disabled, or low-income enrollees who may face difficulty navigating the reinstatement process. State Medicaid agencies, which would bear administrative and IT costs to implement quarterly Death Master File checks. States that already conduct less frequent checks would face new compliance burdens and potential federal penalties for non-compliance.
Supporters argue
Supporters argue that paying for healthcare on behalf of deceased individuals is a straightforward form of waste that undermines public trust in Medicaid and diverts limited funds from living beneficiaries. They contend that the Death Master File is a readily available federal resource, and that requiring only quarterly checks — a modest frequency — is a reasonable, low-cost administrative safeguard. They point to repeated Government Accountability Office and HHS Inspector General findings that improper payments, including payments for deceased beneficiaries, have cost the Medicaid program hundreds of millions of dollars annually, and that a uniform federal standard is needed because state practices currently vary widely.
Opponents argue
Opponents argue that the Death Master File has a documented history of errors, including false positives that have previously caused living people to lose Social Security and other federal benefits — meaning mandatory, automatic disenrollment based solely on this file could wrongly cut off healthcare coverage for vulnerable people who depend on Medicaid for life-sustaining treatment. They contend that while the bill includes a reinstatement provision, even a brief coverage gap could cause serious harm to enrollees managing chronic conditions or requiring ongoing prescriptions. They further argue that the bill imposes new unfunded administrative mandates on states without providing resources to cover implementation costs, raising concerns under the Spending Clause's limits on federal conditions attached to program funding.
Constitutional context
Congress conditions Medicaid funding on state compliance with federal eligibility requirements under the Taxing and Spending Clause (Art. I, §8, cl. 1). NFIB v. Sebelius (2012) established that such conditions are permissible so long as they do not cross into unconstitutional coercion — i.e., states must retain a genuine choice. Adding a new verification requirement to an existing program is well within the established pattern of conditional spending, though states could argue that unfunded mandates with compliance consequences approach coercive territory.
Checks and balances
Congress gains authority by setting a new uniform federal eligibility verification standard for Medicaid; states retain implementation discretion and are checked by the bill's reinstatement requirement, while HHS oversees compliance and courts could review coercion claims under the Spending Clause.
Historical precedent
The Social Security Administration has previously used the Death Master File to terminate benefits for deceased recipients, and Congress has mandated similar cross-checks in Medicare and other federal programs, though no prior law has specifically required quarterly Death Master File verification as a condition of Medicaid participation.