S.B. No. 961 aims to enhance fraud prevention and eligibility verification for Medicaid benefits in Texas. The bill introduces several amendments to the Government Code and Human Resources Code, including a mandate that the commission must conduct periodic electronic data matches to verify a Medicaid recipient's income eligibility without the option to waive this requirement. Additionally, the bill requires the commission to perform monthly electronic data matches with the Texas Lottery Commission to check for reportable lottery winnings among Medicaid recipients and their household members. It also stipulates that the commission must review out-of-state electronic benefit transfer card transactions to identify potential changes in residency that could affect Medicaid eligibility.

Furthermore, the bill establishes that self-attestation of various eligibility criteria, such as income and residency, will not be accepted without additional verification, which must be obtained through electronic data matching before enrollment in the medical assistance program. The bill also expands the definition of unlawful acts related to healthcare fraud, including the failure to disclose the type of license held by healthcare providers. The provisions of this act will take effect on September 1, 2025, and will apply only to unlawful acts committed on or after that date.

Statutes affected:
Introduced: Human Resources Code 36.002 (Human Resources Code 36)
Senate Committee Report: Human Resources Code 36.002 (Human Resources Code 36)
Engrossed: Human Resources Code 36.002 (Human Resources Code 36)