§1396w — Title 42 The Public Health and Welfare | U.S. Code

Summary

Each State must set up a program to check the bank and other financial records of people getting or applying for Medicaid because they are aged, blind, or disabled. States must send a plan to the federal Secretary by the deadlines the Secretary sets and start using the program for eligibility decisions six months after they send the plan. California, New York, and New Jersey had to start by the end of fiscal year 2009. Other States had to roll it out so that about 12.5% of enrollees were covered by the end of FY2009, 25% by FY2010, 50% by FY2011, 75% by FY2012, and 100% by FY2013. Puerto Rico must start by January 1, 2026. The rule applies to the 50 States, the District of Columbia, and Puerto Rico. People (and any other person whose money must be counted) must give written permission for the State to get their financial records from banks at no cost to them. The State uses those records to check assets and decide or redecide Medicaid eligibility. The permission stays in effect until a final denial, the person loses eligibility, or the person revokes it in writing. States must tell people how long the permission lasts and what it covers. If someone refuses or revokes permission, the State may find them ineligible. States can hire contractors who must follow the same privacy rules. The federal government will give technical help and require reports. If a State has not submitted an approved plan and is not operating the program, its federal Medicaid match rate is cut by set amounts: for 2021–2022 by 0.12 percentage points, 2023 by 0.25, 2024 by 0.35, and 2025 and later by 0.5. Puerto Rico faces similar cuts starting in fiscal year 2026 (0.12), then 0.25 in FY2027, 0.35 in FY2028, and 0.5 in FY2029 and after.

Title 42, §1396w

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)Subject to the provisions of this section, each State shall implement an asset verification program described in subsection (b), for purposes of determining or redetermining the eligibility of an individual for medical assistance under the State plan under this subchapter.

(2)In order to meet the requirement of paragraph (1), each State shall—

(A)submit not later than a deadline specified by the Secretary consistent with paragraph (3), a State plan amendment under this subchapter that describes how the State intends to implement the asset verification program; and

(B)provide for implementation of such program for eligibility determinations and redeterminations made on or after 6 months after the deadline established for submittal of such plan amendment.

(3)(A)(i)The Secretary shall require those States specified in subparagraph (C) (to which an asset verification program has been applied before June 30, 2008) to implement an asset verification program under this subsection by the end of fiscal year 2009.

(ii)The Secretary shall require other States to submit and implement an asset verification program under this subsection in such manner as is designed to result in the application of such programs, in the aggregate for all such other States, to enrollment of approximately, but not less than, the following percentage of enrollees, in the aggregate for all such other States, by the end of the fiscal year involved:

(I)12.5 percent by the end of fiscal year 2009.

(II)25 percent by the end of fiscal year 2010.

(III)50 percent by the end of fiscal year 2011.

(IV)75 percent by the end of fiscal year 2012.

(V)100 percent by the end of fiscal year 2013.

(iii)The Secretary shall require Puerto Rico to implement an asset verification program under this subsection by January 1, 2026.

(B)In selecting States under subparagraph (A)(ii), the Secretary shall consult with the States involved and take into account the feasibility of implementing asset verification programs in each such State.

(C)The States specified in this subparagraph are California, New York, and New Jersey.

(D)Nothing in subparagraph (A)(ii) shall be construed as preventing a State from requesting, and the Secretary from approving, the implementation of an asset verification program in advance of the deadline otherwise established under such subparagraph.

(4)This section shall only apply to the 50 States, the District of Columbia, and Puerto Rico.

(b)(1)For purposes of this section, an asset verification program means a program described in paragraph (2) under which a State—

(A)requires each applicant for, or recipient of, medical assistance under the State plan under this subchapter on the basis of being aged, blind, or disabled to provide authorization by such applicant or recipient (and any other person whose resources are required by law to be disclosed to determine the eligibility of the applicant or recipient for such assistance) for the State to obtain (subject to the cost reimbursement requirements of section 1115(a) of the Right to Financial Privacy Act 11 See References in Text note below. [12 U.S.C. 3415] but at no cost to the applicant or recipient) from any financial institution (within the meaning of section 1101(1) of such Act [12 U.S.C. 3401(1)]) any financial record (within the meaning of section 1101(2) of such Act) held by the institution with respect to the applicant or recipient (and such other person, as applicable), whenever the State determines the record is needed in connection with a determination with respect to such eligibility for (or the amount or extent of) such medical assistance; and

(B)uses the authorization provided under subparagraph (A) to verify the financial resources of such applicant or recipient (and such other person, as applicable), in order to determine or redetermine the eligibility of such applicant or recipient for medical assistance under the State plan.

(2)A program described in this paragraph is a program for verifying individual assets in a manner consistent with the approach used by the Commissioner of Social Security under section 1383(e)(1)(B)(ii) of this title.

(c)Notwithstanding section 1104(a)(1) of the Right to Financial Privacy Act 1 [12 U.S.C. 3404(a)(1)], an authorization provided to a State under subsection (b)(1) shall remain effective until the earliest of—

(1)the rendering of a final adverse decision on the applicant’s application for medical assistance under the State’s plan under this subchapter;

(2)the cessation of the recipient’s eligibility for such medical assistance; or

(3)the express revocation by the applicant or recipient (or such other person described in subsection (b)(1), as applicable) of the authorization, in a written notification to the State.

(d)(1)An authorization obtained by the State under subsection (b)(1) shall be considered to meet the requirements of the Right to Financial Privacy Act 1 for purposes of section 1103(a) of such Act [12 U.S.C. 3403(a)], and need not be furnished to the financial institution, notwithstanding section 1104(a) of such Act [12 U.S.C. 3404(a)].

(2)The certification requirements of section 1103(b) of the Right to Financial Privacy Act 1 [12 U.S.C. 3403(b)] shall not apply to requests by the State pursuant to an authorization provided under subsection (b)(1).

(3)A request by the State pursuant to an authorization provided under subsection (b)(1) is deemed to meet the requirements of section 1104(a)(3) of the Right to Financial Privacy Act 1 [12 U.S.C. 3404(a)(3)] and of section 1102 of such Act [12 U.S.C. 3402], relating to a reasonable description of financial records.

(e)The State shall inform any person who provides authorization pursuant to subsection (b)(1)(A) of the duration and scope of the authorization.

(f)If an applicant for, or recipient of, medical assistance under the State plan under this subchapter (or such other person described in subsection (b)(1), as applicable) refuses to provide, or revokes, any authorization made by the applicant or recipient (or such other person, as applicable) under subsection (b)(1)(A) for the State to obtain from any financial institution any financial record, the State may, on that basis, determine that the applicant or recipient is ineligible for medical assistance.

(g)For purposes of implementing an asset verification program under this section, a State may select and enter into a contract with a public or private entity meeting such criteria and qualifications as the State determines appropriate, consistent with requirements in regulations relating to general contracting provisions and with section 1396b(i)(2) of this title. In carrying out activities under such contract, such an entity shall be subject to the same requirements and limitations on use and disclosure of information as would apply if the State were to carry out such activities directly.

(h)The Secretary shall provide States with technical assistance to aid in implementation of an asset verification program under this section.

(i)A State implementing an asset verification program under this section shall furnish to the Secretary such reports concerning the program, at such times, in such format, and containing such information as the Secretary determines appropriate.

(j)Notwithstanding any other provision of law, reasonable expenses of States in carrying out the program under this section shall be treated, for purposes of section 1396b(a) of this title, in the same manner as State expenditures specified in paragraph (7) of such section.

(k)(1)With respect to a calendar quarter, the Federal medical assistance percentage otherwise determined under section 1396d(b) of this title for—

(A)a non-compliant State that is one of the 50 States or the District of Columbia shall be reduced—

(i)for calendar quarters in 2021 and 2022, by 0.12 percentage points;

(ii)for calendar quarters in 2023, by 0.25 percentage points;

(iii)for calendar quarters in 2024, by 0.35 percentage points; and

(iv)for calendar quarters in 2025 and each year thereafter, by 0.5 percentage points; and

(B)a non-compliant State that is Puerto Rico shall be reduced—

(i)for calendar quarters in fiscal year 2026 beginning on or after January 1, 2026, by 0.12 percentage points;

(ii)for calendar quarters in fiscal year 2027, by 0.25 percentage points;

(iii)for calendar quarters in fiscal year 2028, by 0.35 percentage points; and

(iv)for calendar quarters in fiscal year 2029 and each fiscal year thereafter, by 0.5 percentage points.

(2)For purposes of this subsection, the term “non-compliant State” means a State—

(A)that is one of the 50 States, the District of Columbia, or Puerto Rico;

(B)with respect to which the Secretary has not approved a State plan amendment submitted under subsection (a)(2); and

(C)that is not operating, on an ongoing basis, an asset verification program in accordance with this section.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Right to Financial Privacy Act, referred to in subsecs. (b) to (d), probably means the Right to Financial Privacy Act of 1978, title XI of Pub. L. 95–630, Nov. 10, 1978, 92 Stat. 3697, which is classified generally to chapter 35 (§ 3401 et seq.) of Title 12, Banks and Banking. For complete classification of this Act to the Code, see

Short Title

note set out under section 3401 of Title 12 and Tables.

Amendments

2022—Subsec. (a)(3)(A)(iii). Pub. L. 117–328, § 5101(c)(1)(A), added cl. (iii). Subsec. (a)(4). Pub. L. 117–328, § 5101(c)(1)(B), substituted “Exemption of certain territories” for “Exemption of territories” in heading and “, the District of Columbia, and Puerto Rico” for “and the District of Columbia” in text. Subsec. (k)(1). Pub. L. 117–328, § 5101(c)(2)(A), in introductory provisions, struck out “beginning on or after January 1, 2021” after “With respect to a calendar quarter”; substituted “for—” and subpar. (A) for “for a non-compliant State shall be reduced—”; redesignated former subpars. (A) to (D) as cls. (i) to (iv), respectively, of subpar. (A) and realigned margins; and added subpar. (B). Subsec. (k)(2)(A). Pub. L. 117–328, § 5101(c)(2)(B), substituted “, the District of Columbia, or Puerto Rico” for “or the District of Columbia”. 2019—Subsec. (k). Pub. L. 116–3 added subsec. (k).

§1396w Asset verification through access to information held by financial institutions