LIVE Beneficiaries Act

Bill Summary

H.R. 1403, the Leveraging Integrity and Verification of Eligibility for Beneficiaries Act (LIVE Beneficiaries Act), makes a targeted change to Medicaid program integrity rules to ensure that deceased individuals do not remain enrolled and that payments do not continue after a beneficiary’s death. It amends section 1902 of the Social Security Act to require every state (limited to the 50 states and the District of Columbia) to follow new eligibility verification procedures laid out in a newly added subsection (uu). The bill’s core requirement is straightforward: beginning January 1, 2027, states must check the Social Security Administration’s Death Master File (DMF) at least quarterly against their Medicaid enrollment files to verify whether any current enrollees are listed as deceased.

If a state identifies, through the DMF, that an enrollee is deceased, the bill instructs the state to treat that DMF information as sufficient factual confirmation of death for purposes of federal Medicaid regulations that allow termination of coverage without advance notice when a beneficiary has died (referencing 42 C.F.R. 431.213(a)). With that confirmation, the state must promptly disenroll the deceased person and stop making any Medicaid payments on their behalf. Payments for services provided prior to the date of death would still be allowed and paid, but ongoing fee-for-service payments or managed care capitation payments after death must cease.

Recognizing that no data system is perfect, the bill includes an explicit safeguard for erroneous matches. If a state later determines that a living enrollee was misidentified as deceased due to an error in the DMF or in the data matching process, the state must immediately reinstate that person’s Medicaid coverage and make the reinstatement retroactive to the date coverage was erroneously ended. This aims to ensure that any care the individual received during the gap is covered and that financial harm to providers or beneficiaries is minimized.

The measure also clarifies that nothing prevents a state from using other electronic data sources to detect deaths more quickly or comprehensively. States may, for example, use state vital records, interstate data exchanges, or other federal databases to flag potentially deceased beneficiaries. However, the quarterly DMF check remains a minimum federal requirement that all states must meet starting in 2027, alongside all other existing eligibility determination and redetermination rules.

Functionally, the bill creates a uniform national floor for death-data screening frequency in Medicaid. Many states already perform periodic death matches, but practices vary, and some may not check as frequently as quarterly. By standardizing a minimum cadence and explicitly authorizing use of DMF data as sufficient proof for immediate termination in death cases, the bill seeks to reduce improper payments—such as ongoing capitation to managed care plans for enrollees who have died—and strengthen program integrity.

The bill is narrowly tailored: it addresses only verification related to death status and does not expand into other eligibility criteria (like residency, income, or immigration status). It does not alter who qualifies for Medicaid or the scope of covered benefits. Nor does it impose reporting requirements or penalties specified in the text; enforcement would be through the existing Medicaid state plan compliance framework administered by the Centers for Medicare & Medicaid Services (CMS). The effective date of January 1, 2027, provides states time to ensure access to the DMF, update their IT systems, and adjust processes with managed care plans and providers to recoup or prevent payments after death.

While the bill’s focus is program integrity and taxpayer savings, it raises practical considerations. State agencies will need to maintain accurate identifiers to avoid mismatches, establish rapid reinstatement workflows for false positives, and coordinate with managed care organizations to stop capitation promptly and reconcile partial-month payments. The reference to the no-advance-notice rule in death cases accelerates disenrollment when a DMF match occurs, which helps prevent waste but could heighten due-process concerns if the match is wrong. The retroactive reinstatement requirement is intended to mitigate that risk. Finally, the bill applies only to the 50 states and the District of Columbia, not to U.S. territories, and it does not include direct federal funding for states’ implementation costs. Overall, it is a targeted, bipartisan program-integrity measure focused on preventing Medicaid payments after a beneficiary’s death while providing a remedy for errors.

Where Each Party Stands

History