H.B. No. 4273 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 and prohibits the waiver of 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 transactions to identify potential changes in residency that could affect Medicaid eligibility.

Furthermore, the bill establishes stricter verification processes for self-attested eligibility criteria, stating that self-attestation of income, residency, and other factors cannot be accepted without additional verification, which should be pursued through electronic data matching before requesting documentation from the individual. The bill also expands the definition of unlawful acts related to healthcare fraud, including new requirements for claims made under healthcare programs. The provisions of this act are set to 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)
House Committee Report: Human Resources Code 36.002 (Human Resources Code 36)
Engrossed: Human Resources Code 36.002 (Human Resources Code 36)
Senate Committee Report: Government Code 544.0455, Government Code 544.0456, Human Resources Code 36.002 (Human Resources Code 36, Government Code 544)