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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: December 1, 2022 01:06 PM
From: Representative Perry A. Stambaugh
To: All House members
Subject: Medical Assistance Integrity Waivers
I am reintroducing legislation (HB 2392 from last session) to add section 443.13 to the Human Services Code, which will effectuate new waivers under the medical assistance program to increase integrity. While waivers must be approved by the federal government, I believe this is an important step in ensuring our medical assistance program remains available for our most vulnerable citizens and keeps fraudsters out of the system.

Specifically, my legislation will require the Pennsylvania Department of Human Services (DHS) to annually apply for waivers for the following reasons:
  • Fraud lockout – prohibit re-enrollment and deny eligibility for up to six months for non-disabled, non-pregnant adults between the ages of 19-64 years who fail to report changes in circumstances impacting their eligibility.
  • Redetermination waiver – enable DHS to redetermine eligibility every six months instead of annually.
  • Suspension of automatic renewal and prepopulated forms to ensure redeterminations occur using correct information.
These three simple, common-sense waivers will ensure we keep fraudsters out of our medical assistance programs and that our finite tax dollars only go to those vulnerable citizens who truly need assistance. 

I hope you will join me in this legislative proposal to bring integrity to our medical assistance program.

Introduced as HB331