Section 1. Section 26B-3-142.1 is enacted to read:26B-3-142.1Effective 01/01/27. Medicaid work requirements.(1)As used in this section:(a)"Applicable individual" means an individual who:(i)is eligible to enroll in Medicaid under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); or(ii)(A)is eligible to enroll under a waiver that provides coverage that is equivalent to minimum essential coverage as described in 26 U.S.C. Sec. 5000A;(B)is at least 19 years old and younger than 65 years old;(C)is not pregnant;(D)is not entitled to, enrolled for, or eligible to enroll for, benefits under Part A of Title XVIII of the Social Security Act; and(E)is not entitled to, enrolled for, or eligible to enroll for, benefits under Part B of Title XVIII of the Social Security Act.(b)"Health care professional" means an individual practicing within the scope of the individual's professional license.(c)"Work requirements" means the requirements established by 42 U.S.C. Sec. 1396a(xx).(2)The department shall implement work requirements for applicable individuals.(3)(a)The department may not enroll an applicable individual in Medicaid unless, at the time of application, the individual demonstrates compliance with the work requirements for one month immediately preceding the month during which the individual applies.(b)The department:(i)shall use documentary evidence, including claims data; and(ii)may not rely exclusively on self-attestation as evidence.(c)The department shall verify an applicable individual's compliance with work requirements through state wage data, Department of Workforce Services records, education or training program enrollment, or verified volunteer service documentation.(d)The department shall verify that an applicable individual complied with work requirements for one month during the applicable individual's current eligibility period before completing the applicable individual's next redetermination of eligibility.(4)(a)An applicable individual seeking an exemption from work requirements shall provide documentation for the exemption sought unless the department is able to make the determination through other reliable sources of information.(b)The department:(i)shall verify all exemptions;(ii)may not accept exemption designations, approvals, or determinations by a managed care organization; and(iii)may accept data provided by a managed care organization to verify or make a determination regarding an exemption.(c)If the individual is attempting to obtain an exemption from the work requirements because the individual is medically frail or otherwise an individual with special needs, and electronic data is determined insufficient, the department may:(i)provisionally approve the exemption based on a diagnosis identified by the individual; and(ii)shall verify the exemption using electronic data or through a statement from a health care professional indicating the individual as:(A)being blind or disabled as defined in 42 U.S.C. Sec. 1382c(2) or (3);(B)having a disabling mental disorder;(C)having a physical, intellectual, or developmental disability that significantly impairs the individual's ability to perform one or more activities of daily living, which may include eating, dressing, bathing, grooming, getting in and out of bed and chairs, walking, going outdoors, or using the toilet;(D)having a substance use disorder; or(E)having a serious or complex medical condition.(5)Once work requirements are implemented, beginning August 31, 2027, and no later than August 31 of each subsequent year, the department shall submit annual reports to the Health and Human Services Interim Committee and the governor on compliance rates, the number and type of exemptions granted, and the impact on Medicaid enrollment.

Section 2. Section 26B-3-142.2 is enacted to read:26B-3-142.2Effective 01/01/27. Verification of eligibility.(1)Except as required under federal law, the department may not accept self-attestation of any of the following in the administration of the Medicaid program without verification before enrollment:(a)income;(b)residency;(c)identity; and(d)citizenship or immigration status.(2)Upon receiving information concerning an enrollee that indicates a change in circumstances that may affect Medicaid eligibility, the department shall promptly conduct an eligibility determination for the recipient.(3)Except as provided in federal law, the department shall conduct an eligibility redetermination for an enrollee:(a)eligible under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII) once every six months; and(b)not described in Subsection (3)(a) once every 12 months.

Section 3. Section 26B-3-142.3 is enacted to read:26B-3-142.3Effective 05/06/26. Citizenship requirements.(1)As used in this section, "qualified citizen" means a resident of the United States and meets at least one of the following criteria:(a)a citizen or national of the United States;(b)an alien lawfully admitted for permanent residence as an immigrant, as defined in 8 U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists, diplomats, students, or other individuals admitted temporarily without intent to abandon their residence in a foreign country;(c)an alien who has been granted the status of Cuban or Haitian entrant, as defined in Section 501(e) of the Refugee Education Assistance Act of 1980;(d)an individual lawfully residing in the United States in accordance with a Compact of Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G); or(e)a lawfully present child described in 42 U.S.C. Sec. 1396b(v)(4).(2)Beginning on October 1, 2026, the department:(a)unless required by federal law, may not provide medical assistance to any individual unless that individual is a qualified citizen;(b)shall require that all income of ineligible household members of the applicant be included when calculating financial eligibility for Medicaid to the extent allowed under federal law;(c)shall include an immigration status on all presumptive eligibility applications submitted to the agency;(d)shall require hospitals, clinics, and other qualified entities conducting presumptive eligibility determinations to collect and transmit any attestation to the agency;(e)may not allow a presumptive eligibility application to be approved unless the applicant attests that the applicant is a qualified citizen; and(f)shall conduct regular cross-checks of applicant and enrollee information against federal databases, including the Systematic Alien Verification for Entitlements program.

Section 4. Section 26B-3-142.4 is enacted to read:26B-3-142.4Effective 01/01/27. Multi-state enrollment.(1)(a)The department shall:(i)receive and review address change information from returned mail by the United States Postal Service, the National Change of Address database, and accountable care organizations;(ii)conduct cross-checks regarding all address change information against state Medicaid enrollment to identify enrollees who have moved out of state;(iii)receive and review information regarding out-of-state electronic benefit transactions; and(iv)conduct cross-checks of out-of-state electronic benefit transactions against state Medicaid enrollment to identify enrollees who have moved out of state.(b)Upon receiving information concerning an enrollee that indicates a change in circumstances that may affect Medicaid eligibility, including a change in residency, the department shall promptly conduct an eligibility determination for the recipient.(2)Beginning no later than October 1, 2029, the department shall submit enrollment information to CMS's national Medicaid enrollment database every month to identify individuals enrolled in Medicaid in multiple states at the same time.(3)(a)Beginning August 31, 2028, and no later than August 31 of each subsequent year, the department shall submit an annual report to the Health and Human Services Interim Committee detailing the implementation of the requirements established in this section.(b)The report shall include for the prior fiscal year:(i)the number of enrollees flagged through address change information and out-of-state electronic benefit transactions;(ii)the number of enrollees disenrolled from the Medicaid program due to enrollment in multiple states; and(iii)the estimated fiscal impact to the state due to implementing the requirements of this section.

Section 5. Section 26B-3-142.5 is enacted to read:26B-3-142.5Effective 05/06/26. Remove deceased enrollees.(1)As used in this section, "death master file" means the database maintained by the Social Security Administration that contains reported deaths.(2)The department shall:(a)receive and review information from the death master file;(b)conduct cross-checks between information obtained from the death master file and state Medicaid enrollment at least each quarter to identify deceased enrollees;(c)receive and review information regarding birth and death records from the Office of Vital Records and Statistics;(d)remove any identified deceased enrollee from the Medicaid program promptly upon confirmation of death;(e)ensure that no Medicaid payments are made on behalf of a deceased enrollee for services rendered after the date of death; and(f)recoup any funds expended on deceased enrollees for capitations or services occurring after the date of death.(3)The Office of Inspector General of Medicaid Services, created in Section 63A-13-201, shall conduct periodic reviews to ensure compliance with these requirements.

Section 6. Section 26B-3-142.6 is enacted to read:26B-3-142.6Effective 01/01/27. Retroactive eligibility.(1)As used in this section:(a)"Expansion population" means the population who is enrolled in the Medicaid program under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII).(b)"Traditional population" means the population who is enrolled in Medicaid under a provision of federal law that is not 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII), including pregnant women, children, elderly individuals, and individuals with disabilities.(c)"Retroactive eligibility" means Medicaid coverage for services provided before the month of application, as authorized by 42 U.S.C. Sec. 1396(a)(34).(2)(a)The department shall limit retroactive eligibility for Medicaid benefits as follows:(i)for the expansion population, Medicaid coverage may be made retroactive for no more than one month before the month in which the enrollee submits a completed Medicaid application; and(ii)for the traditional population, Medicaid coverage may be made retroactive for no more than two months before the month in which the individual submits a completed Medicaid application.(b)The limitations described in Subsection (2)(a) apply only to initial applications for Medicaid and do not affect eligibility for continuous or ongoing coverage.(3)(a)In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the department shall make rules necessary to implement and enforce the provisions of this section.(b)The department may establish procedures to notify applicants and providers of changes in eligibility policy, and shall ensure compliance with all federal requirements regarding notice and due process.(4)(a)Beginning on August 31, 2027, and no later than August 31 of each subsequent year, the department shall submit an annual report to the Health and Human Services Interim Committee detailing the implementation and impact of the retroactive benefits limitation established in Subsection (2).(b)The report shall include for the prior fiscal year:(i)the number of Medicaid applications processed for the expansion population and the number of applications processed for the traditional population; and(ii)the estimated savings to the state created due to the benefits limitation established in Subsection (2).

Section 7. Section 35A-17-202 is enacted to read:17. SNAP Benefits2. Work Requirements35A-17-202Effective 05/06/26. Approval of work requirement waiver request -- Prohibition for work requirement discretionary exemption.The department may not submit a waiver for a work requirement in accordance with 7 U.S.C. Sec. 2015(o)(4) unless the waiver is approved by the Legislature and governor by concurrent resolution.

Section 8. Section 35A-17-301 is enacted to read:3. Citizenship35A-17-301Effective 05/06/26. Inclusion of financial resources.(1)The department shall determine an individual's eligibility for SNAP benefits in accordance with 7 U.S.C. Ch. 51, Supplemental Nutrition Assistance Program.(2)Notwithstanding 7 C.F.R. Sec. 273.11(c)(3) and if approved by the United States Department of Agriculture, the department may not prorate or exclude the income, deductions, or financial resources of ineligible aliens in determining the eligibility and the value of the allotment of the household of which the individual is a member.

Section 9. Section 35A-17-302 is enacted to read:35A-17-302Effective 05/06/26. Citizenship requirements.(1)In accordance with 7 U.S.C. Sec. 2015(f), an individual may not participate in SNAP benefits unless the individual:(a)is a resident of the United States; and(b)meets at least one of the following criteria:(i)is a citizen or national of the United States;(ii)is an alien lawfully admitted for permanent residence as an immigrant, as defined in 8 U.S.C. Secs. 1101(a)(15) and 1101(a)(20), excluding alien visitors, tourists, diplomats, students, or other individuals admitted temporarily without intent to abandon their residence in a foreign country;(iii)is an alien who has been granted the status of Cuban or Haitian entrant, as defined in Section 501(e) of the Refugee Education Assistance Act of 1980; or(iv)is an individual lawfully residing in the United States in accordance with a Compact of Free Association, as referenced in 8 U.S.C. Sec. 1612(b)(2)(G).(2)The department shall require an individual to provide documentary proof of citizenship or immigration status to determine eligibility.(3)Acceptable forms of documentary evidence of an individual's citizenship or alien status include:(a)birth or hospital records;(b)voter registration cards;(c)United States passports;(d)United States Citizenship and Immigration Service documentation; or(e)electronically available data.(4)If an individual is unable to provide the documentation described in Subsection (3), the department shall verify the individual's alien status using the Systematic Alien Verification for Entitlements online service during enrollment and eligibility recertification.

Section 10. Effective Date.(1)Except as provided in Subsection (2), this bill takes effect May 6, 2026.(2)The actions affecting the following sections take effect on January 1, 2027:(a)Section 26B-3-142.1Effective 01/01/27;(b)Section 26B-3-142.2Effective 01/01/27;(c)Section 26B-3-142.4Effective 01/01/27; and(d)Section 26B-3-142.6Effective 01/01/27.