HB 471

Enrolled Copy  H.B. 471
1Social Services Amendments
                                       2026 GENERAL SESSION
                                             STATE OF UTAH
                                   Chief Sponsor: Logan J. Monson
                                    Senate Sponsor: Keven J. Stratton
2
3  LONG TITLE
4  General Description:
5      This bill enacts provisions related to social services programs.
6  Highlighted Provisions:
7      This bill:
8      ▸ amends provisions related to the Medicaid program, including:
9●   work requirements for certain Medicaid enrollees;
10●   verification standards for the Department of Health and Human Services (DHHS);
11●   citizenship requirements;
12●   procedures for disenrolling individuals no longer eligible for Medicaid due to death or
13  state residency requirements; and
14●   limiting retroactive eligibility;
15      ▸ amends provisions related to the Supplemental Nutrition Assistance Program, including
16  provisions related to:
17●   work requirements; and
18●   citizenship; and
19      ▸ creates reporting requirements.
20  Money Appropriated in this Bill:
21      None
22  Other Special Clauses:
23      This bill provides a special effective date.
24  Utah Code Sections Affected:
25  ENACTS:
26      26B-3-142.1 (Effective 01/01/27), Utah Code Annotated 1953
27      26B-3-142.2 (Effective 01/01/27), Utah Code Annotated 1953
28      26B-3-142.3 (Effective 05/06/26), Utah Code Annotated 1953
H.B. 471  Enrolled Copy
2926B-3-142.4 (Effective 01/01/27), Utah Code Annotated 1953
3026B-3-142.5 (Effective 05/06/26), Utah Code Annotated 1953
3126B-3-142.6 (Effective 01/01/27), Utah Code Annotated 1953
3235A-17-202 (Effective 05/06/26), Utah Code Annotated 1953
3335A-17-301 (Effective 05/06/26), Utah Code Annotated 1953
3435A-17-302 (Effective 05/06/26), Utah Code Annotated 1953
35
36   Be it enacted by the Legislature of the state of Utah:
37Section 1. Section 26B-3-142.1 is enacted to read:
3826B-3-142.1 (Effective 01/01/27). Medicaid work requirements.
39   (1) As used in this section:
40(a) "Applicable individual" means an individual who:
41(i) is eligible to enroll in Medicaid under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); or
42(ii)(A) is eligible to enroll under a waiver that provides coverage that is equivalent
43to minimum essential coverage as described in 26 U.S.C. Sec. 5000A;
44(B) is at least 19 years old and younger than 65 years old;
45(C) is not pregnant;
46(D) is not entitled to, enrolled for, or eligible to enroll for, benefits under Part A of
47Title XVIII of the Social Security Act; and
48(E) is not entitled to, enrolled for, or eligible to enroll for, benefits under Part B of
49Title XVIII of the Social Security Act.
50(b) "Health care professional" means an individual practicing within the scope of the
51individual's professional license.
52(c) "Work requirements" means the requirements established by 42 U.S.C. Sec.
531396a(xx).
54   (2) The department shall implement work requirements for applicable individuals.
55   (3)(a) The department may not enroll an applicable individual in Medicaid unless, at the
56time of application, the individual demonstrates compliance with the work
57requirements for one month immediately preceding the month during which the
58individual applies.
59(b) The department:
60(i) shall use documentary evidence, including claims data; and
61(ii) may not rely exclusively on self-attestation as evidence.
62(c) The department shall verify an applicable individual's compliance with work
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63requirements through state wage data, Department of Workforce Services records,
64education or training program enrollment, or verified volunteer service
65documentation.
66      (d) The department shall verify that an applicable individual complied with work
67requirements for one month during the applicable individual's current eligibility
68period before completing the applicable individual's next redetermination of
69eligibility.
70  (4)(a) An applicable individual seeking an exemption from work requirements shall
71      provide documentation for the exemption sought unless the department is able to
72      make the determination through other reliable sources of information.
73      (b) The department:
74(i) shall verify all exemptions;
75(ii) may not accept exemption designations, approvals, or determinations by a
76managed care organization; and
77(iii) may accept data provided by a managed care organization to verify or make a
78determination regarding an exemption.
79      (c) If the individual is attempting to obtain an exemption from the work requirements
80because the individual is medically frail or otherwise an individual with special
81needs, and electronic data is determined insufficient, the department may:
82(i) provisionally approve the exemption based on a diagnosis identified by the
83individual; and
84(ii) shall verify the exemption using electronic data or through a statement from a
85health care professional indicating the individual as:
86(A) being blind or disabled as defined in 42 U.S.C. Sec. 1382c(2) or (3);
87(B) having a disabling mental disorder;
88(C) having a physical, intellectual, or developmental disability that significantly
89impairs the individual's ability to perform one or more activities of daily living,
90which may include eating, dressing, bathing, grooming, getting in and out of
91bed and chairs, walking, going outdoors, or using the toilet;
92(D) having a substance use disorder;
93(E) having a serious or complex medical condition; or
94(F) experiencing homelessness.
95  (5) Once work requirements are implemented, beginning August 31, 2027, and no later than
96      August 31 of each subsequent year, the department shall submit annual reports to the
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97Health and Human Services Interim Committee and the governor on compliance rates,
98the number and type of exemptions granted, and the impact on Medicaid enrollment.
99Section 2. Section 26B-3-142.2 is enacted to read:
10026B-3-142.2 (Effective 01/01/27). Verification of eligibility.
101   (1) Except as required under federal law, the department may not accept self-attestation of
102any of the following in the administration of the Medicaid program without verification
103before enrollment:
104(a) income;
105(b) residency;
106(c) identity; and
107(d) citizenship or immigration status.
108   (2) Upon receiving information concerning an enrollee that indicates a change in
109circumstances that may affect Medicaid eligibility, the department shall promptly
110conduct an eligibility determination for the enrollee unless the enrollee has continuous
111eligibility in accordance with state and federal law.
112   (3) Except as provided in federal law, the department shall conduct an eligibility
113redetermination for an enrollee:
114(a) eligible under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII) once every six months; and
115(b) not described in Subsection (3)(a) once every 12 months.
116Section 3. Section 26B-3-142.3 is enacted to read:
11726B-3-142.3 (Effective 05/06/26). Citizenship requirements.
118   (1) As used in this section, "qualified citizen" means a resident of the United States and
119meets at least one of the following criteria:
120(a) a citizen or national of the United States;
121(b) an alien lawfully admitted for permanent residence as an immigrant, as defined in 8
122U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists,
123diplomats, students, or other individuals admitted temporarily without intent to
124abandon their residence in a foreign country;
125(c) an alien who has been granted the status of Cuban or Haitian entrant, as defined in S
126ection 501(e) of the Refugee Education Assistance Act of 1980;
127(d) an individual lawfully residing in the United States in accordance with a Compact of
128Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G); or
129(e) a lawfully present child described in 42 U.S.C. Sec. 1396b(v)(4).
130   (2) Beginning on October 1, 2026, the department:
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131      (a) unless required by federal law, may not provide medical assistance to any individual
132unless that individual is a qualified citizen;
133      (b) shall require that all income of ineligible household members of the applicant be
134included when calculating financial eligibility for Medicaid to the extent allowed
135under federal law;
136      (c) shall include an immigration status on all presumptive eligibility applications
137submitted to the agency;
138      (d) shall require hospitals, clinics, and other qualified entities conducting presumptive
139eligibility determinations to collect and transmit any attestation to the agency;
140      (e) may not allow a presumptive eligibility application to be approved unless the
141applicant attests that the applicant is a qualified citizen; and
142      (f) shall conduct regular cross-checks of applicant and enrollee information against
143federal databases, including the Systematic Alien Verification for Entitlements
144program.
145Section 4. Section 26B-3-142.4 is enacted to read:
14626B-3-142.4 (Effective 01/01/27). Multi-state enrollment.
147  (1)(a) The department shall:
148(i) receive and review address change information from returned mail by the United
149States Postal Service, the National Change of Address database, and accountable
150care organizations;
151(ii) conduct cross-checks regarding all address change information against state
152Medicaid enrollment to identify enrollees who have moved out of state;
153(iii) receive and review information regarding out-of-state electronic benefit
154transactions; and
155(iv) conduct cross-checks of out-of-state electronic benefit transactions against state
156Medicaid enrollment to identify enrollees who have moved out of state.
157      (b) Upon receiving information concerning an enrollee that indicates a change in
158circumstances that may affect Medicaid eligibility, including a change in residency,
159the department shall promptly conduct an eligibility determination for the recipient.
160  (2) Beginning no later than October 1, 2029, the department shall submit enrollment
161      information to CMS's national Medicaid enrollment database every month to identify
162      individuals enrolled in Medicaid in multiple states at the same time.
163  (3)(a) Beginning August 31, 2028, and no later than August 31 of each subsequent year,
164      the department shall submit an annual report to the Health and Human Services
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165Interim Committee detailing the implementation of the requirements established in
166this section.
167(b) The report shall include for the prior fiscal year:
168(i) the number of enrollees flagged through address change information and
169out-of-state electronic benefit transactions;
170(ii) the number of enrollees disenrolled from the Medicaid program due to enrollment
171in multiple states; and
172(iii) the estimated fiscal impact to the state due to implementing the requirements of
173this section.
174Section 5. Section 26B-3-142.5 is enacted to read:
17526B-3-142.5 (Effective 05/06/26). Remove deceased enrollees.
176   (1) As used in this section, "death master file" means the database maintained by the Social
177Security Administration that contains reported deaths.
178   (2) The department shall:
179(a) receive and review information from the death master file;
180(b) conduct cross-checks between information obtained from the death master file and
181state Medicaid enrollment at least each quarter to identify deceased enrollees;
182(c) receive and review information regarding birth and death records from the Office of
183Vital Records and Statistics;
184(d) remove any identified deceased enrollee from the Medicaid program promptly upon
185confirmation of death;
186(e) ensure that no Medicaid payments are made on behalf of a deceased enrollee for
187services rendered after the date of death; and
188(f) recoup any funds expended on deceased enrollees for capitations or services
189occurring after the date of death.
190   (3) The Office of Inspector General of Medicaid Services, created in Section 63A-13-201,
191shall conduct periodic reviews to ensure compliance with these requirements.
192Section 6. Section 26B-3-142.6 is enacted to read:
19326B-3-142.6 (Effective 01/01/27). Retroactive eligibility.
194   (1) As used in this section:
195(a) "Expansion population" means the population who is enrolled in the Medicaid
196program under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII).
197(b) "Traditional population" means the population who is enrolled in Medicaid under a
198provision of federal law that is not 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII),
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199including pregnant women, children, elderly individuals, and individuals with
200disabilities.
201      (c) "Retroactive eligibility" means Medicaid coverage for services provided before the
202month of application, as authorized by 42 U.S.C. Sec. 1396(a)(34).
203  (2)(a) The department shall limit retroactive eligibility for Medicaid benefits as follows:
204(i) for the expansion population, Medicaid coverage may be made retroactive for no
205more than one month before the month in which the enrollee submits a completed
206Medicaid application; and
207(ii) for the traditional population, Medicaid coverage may be made retroactive for no
208more than two months before the month in which the individual submits a
209completed Medicaid application.
210      (b) The limitations described in Subsection (2)(a) apply only to initial applications for
211Medicaid and do not affect eligibility for continuous or ongoing coverage.
212  (3)(a) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
213      the department shall make rules necessary to implement and enforce the provisions of
214      this section.
215      (b) The department may establish procedures to notify applicants and providers of
216changes in eligibility policy, and shall ensure compliance with all federal
217requirements regarding notice and due process.
218  (4)(a) Beginning on August 31, 2027, and no later than August 31 of each subsequent
219      year, the department shall submit an annual report to the Health and Human Services
220      Interim Committee detailing the implementation and impact of the retroactive
221      benefits limitation established in Subsection (2).
222      (b) The report shall include for the prior fiscal year:
223(i) the number of Medicaid applications processed for the expansion population and
224the number of applications processed for the traditional population; and
225(ii) the estimated savings to the state created due to the benefits limitation established
226in Subsection (2).
227Section 7. Section 35A-17-202 is enacted to read:
228CHAPTER 17. SNAP Benefits
229Part 2. Work Requirements
23035A-17-202 (Effective 05/06/26). Approval of work requirement waiver request.
231     The department may not submit a waiver for a work requirement in accordance with 7
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232   U.S.C. Sec. 2015(o)(4) unless the waiver is approved by the Legislature and governor by
233   concurrent resolution.
234Section 8. Section 35A-17-301 is enacted to read:
235Part 3. Citizenship
23635A-17-301 (Effective 05/06/26). Inclusion of financial resources.
237   (1) The department shall determine an individual's eligibility for SNAP benefits in
238accordance with 7 U.S.C. Ch. 51, Supplemental Nutrition Assistance Program.
239   (2) Notwithstanding 7 C.F.R. Sec. 273.11(c)(3) and if approved by the United States
240Department of Agriculture, the department may not prorate or exclude the income,
241deductions, or financial resources of ineligible aliens in determining the eligibility and
242the value of the allotment of the household of which the individual is a member.
243Section 9. Section 35A-17-302 is enacted to read:
24435A-17-302 (Effective 05/06/26). Citizenship requirements.
245   (1) In accordance with 7 U.S.C. Sec. 2015(f), an individual may not participate in SNAP
246benefits unless the individual:
247(a) is a resident of the United States; and
248(b) meets at least one of the following criteria:
249(i) is a citizen or national of the United States;
250(ii) is an alien lawfully admitted for permanent residence as an immigrant, as defined
251in 8 U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists,
252diplomats, students, or other individuals admitted temporarily without intent to
253abandon their residence in a foreign country;
254(iii) is an alien who has been granted the status of Cuban or Haitian entrant, as
255defined in Section 501(e) of the Refugee Education Assistance Act of 1980; or
256(iv) is an individual lawfully residing in the United States in accordance with a
257Compact of Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G).
258   (2) The department shall require an individual to provide documentary proof of citizenship
259or immigration status to determine eligibility.
260   (3) Acceptable forms of documentary evidence of an individual's citizenship or alien status
261include:
262(a) birth or hospital records;
263(b) voter registration cards;
264(c) United States passports;
265(d) United States Citizenship and Immigration Service documentation; or
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266      (e) electronically available data.
267  (4) If an individual is unable to provide the documentation described in Subsection (3), the d
268      epartment shall verify the individual's alien status using the Systematic Alien
269      Verification for Entitlements online service during enrollment and eligibility
270      recertification.
271Section 10. Effective Date.
272  (1) Except as provided in Subsection (2), this bill takes effect May 6, 2026.
273  (2) The actions affecting the following sections take effect on January 1, 2027:
274      (a) Section 26B-3-142.1 (Effective 01/01/27);
275      (b) Section 26B-3-142.2 (Effective 01/01/27);
276      (c) Section 26B-3-142.4 (Effective 01/01/27); and
277      (d) Section 26B-3-142.6 (Effective 01/01/27).
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