GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H D
HOUSE BILL DRH30286-MC-165
Short Title: Public Assistance Verification Enhancements. (Public)
Sponsors: Representative Stevens.
Referred to:
*DRH30286 -MC-165*
A BILL TO BE ENTITLED 1
AN ACT TO ENHANCE VERIFICATION OF PUBLIC ASSISTANCE PROGRAMS. 2
The General Assembly of North Carolina enacts: 3
SECTION 1. G.S. 108A-55.5 reads as rewritten: 4
"§ 108A-55.5. Eligibility monitoring for medical public assistance. 5
(a) On at least a quarterly basis, the Department shall review information concerning 6
changes in circumstances that may affect medical assistance beneficiaries' eligibility to receive 7
medical assistance benefits. The Department shall share the information directly with, or make 8
the information available to, the county department of social services that determined the 9
beneficiary's eligibility.An individual may not be considered homeless to grant a work 10
requirement exemption until and unless the Department (i) verifies that an individual has resided 11
in a public shelter for a period of at least 30 days based on notarized documentation from a public 12
shelter of such fact or (ii) certifies that there is no indoor shelter available and provides notarized 13
documentation from a public housing authority that the individual is on a waiting list for benefits. 14
(a1) Definitions. – The following definitions apply in this section: 15
(1) Governmental public assistance entity. – An entity providing public 16
assistance, including the Department of Health and Human Services and 17
public housing authorities. 18
(2) Health and medical assistance programs. – The following programs: 19
a. Supplemental Nutrition Assistance Program, or food stamps. 20
b. Temporary Assistance for Needy Families and Children, also known 21
as Work First. 22
c. Medicaid. 23
(3) Homeless individual. – An individual who (i) has resided in a public shelter 24
for a period of at least 30 days or (ii) has no indoor shelter available and is on 25
the waiting list of a public housing authority for benefits. 26
(4) Public assistance. – The following programs: 27
a. Health and medical assistance. 28
b. Public housing assistance provided by a public housing authority. 29
(5) Public housing authority. – A housing authority operating within the State 30
created pursuant to G.S. 157-4. 31
(b) The information reviewed by the Department shall include all of the following: 32
(1) Earned and unearned income. 33
(2) Employment status and changes in employment. 34
(3) Residency status. 35
(4) Enrollment status in other State-administered public assistance programs. 36
H.B. 640
Apr 1, 2025
HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRH30286-MC-165
(5) Financial resources. 1
(6) Incarceration status. 2
(7) Death records. 3
(8) Lottery winnings. 4
(9) Enrollment status in public assistance programs outside of this State. 5
(b1) Supplemental Nutrition Assistance Program, Temporary Assistance for Needy 6
Families and Children, Medicaid. – Governmental public assistance entities shall take the steps 7
with respect to the sources listed in this subsection as follows: 8
(1) With respect to State databases: 9
a. On at least a monthly basis, the Department of Health and Human 10
Services shall enter into a data matching agreement with the North 11
Carolina State Lottery Commission to identify households with 12
winnings of three thousand dollars ($3,000) or more from the lottery 13
or from gambling and, to the extent permissible under federal law, treat 14
this data as verified upon receipt. To the extent the data may not be 15
verified upon receipt, the Department shall make referrals for further 16
investigation to identify households with winnings equal to or greater 17
than the resource limit for elderly or disabled households as defined in 18
7 C.F.R. § 273.8(b). 19
b. On at least a monthly basis, the Department of Health and Human 20
Services shall receive and review information from the North Carolina 21
Office of Vital Records concerning individuals in households enrolled 22
in health and medical assistance programs that indicates a change in 23
circumstances that may affect eligibility for these programs. 24
c. On at least a quarterly basis, the Department of Health and Human 25
Services shall receive and review information from the Department of 26
Labor concerning individuals in households enrolled in health and 27
medical assistance programs that indicates a change in circumstances 28
that may affect eligibility for these programs, including, but not 29
limited to, changes in employment or wages. 30
d. On at least a monthly basis, the Department of Health and Human 31
Services shall receive and review information concerning individuals 32
in households enrolled in health and medical assistance programs that 33
indicates a change in circumstances that may affect eligibility for these 34
programs, including, but not limited to, potential changes in residency 35
as identified by out-of-state electronic benefit transfer (EBT) card 36
transactions. 37
e. On at least a quarterly basis, the Department of Health and Human 38
Services shall receive and review information from the Department of 39
Revenue concerning individuals in households enrolled in health and 40
medical assistance programs that indicates a change in circumstances 41
that may affect eligibility for these programs, including, but not 42
limited to, potential changes in income, wages, or residency as 43
identified by tax records. 44
f. On at least a monthly basis, the Department of Health and Human 45
Services shall receive and review information from the Department of 46
Adult Correction concerning individuals in households enrolled in 47
health and medical assistance programs that indicates a change in 48
circumstances that may affect eligibility for either program. 49
g. On at least a semimonthly basis, the Department of Health and Human 50
Services shall receive and review information from the Department of 51 General Assembly Of North Carolina Session 2025
DRH30286-MC-165 Page 3
Commerce concerning individuals in households enrolled in health 1
and medical assistance programs that indicates a change in 2
circumstances that may affect eligibility for these programs, including, 3
but not limited to, potential changes in employment, income, or assets. 4
(2) With respect to federal databases, on at least a monthly basis, the Department 5
of Health and Human Services shall review and act on findings affecting 6
eligibility for health and medical assistance programs with respect to the 7
following: 8
a. Earned income information, death register information, incarceration 9
records, supplemental security income information, beneficiary 10
records, earnings information, and pension information maintained by 11
the United States Social Security Administration. 12
b. Income and employment information maintained in the National 13
Directory of New Hires database and child support enforcement data 14
maintained by the United States Department of Health and Human 15
Services. 16
c. Payment and earnings information maintained by the United States 17
Department of Housing and Urban Development. 18
d. National fleeing felon information maintained by the United States 19
Federal Bureau of Investigation. 20
(3) With respect to annual retail site inspections, the Department of Health and 21
Human Services shall, with all necessary coordination with appropriate 22
federal and State law enforcement authorities, conduct an on-site inspection 23
of retailers that accept EBT card transactions to identify suspicious transaction 24
records or amounts indicating possible trafficking of benefits or other criminal 25
conduct and make referrals for proper investigations under applicable law. 26
(b2) Public Posting. – On at least a quarterly basis, the Department of Health and Human 27
Services shall make available to the public on its website data from findings of noncompliance 28
and fraud investigations in health and medical assistance programs for the following aggregate 29
and nonconfidential and nonpersonal identifying information: 30
(1) The number of households investigated for intentional program violations or 31
fraud. 32
(2) The total number of households referred to the Attorney General's office for 33
prosecution. 34
(3) The total amount of improper payments and expenditures. 35
(4) The total amount of monies recovered. 36
(5) Aggregate data concerning improper payments and ineligible recipients as a 37
percentage of those investigated and reviewed. 38
(6) The aggregate amount of funds expended by electronic benefit transfer card 39
transactions in each state outside of North Carolina. 40
(b3) Medicaid Application. – Unless required under federal law, the Department may not 41
accept self-attestation of income, residency, age, household composition, caretaker or relative 42
status, or receipt of other coverage without verification prior to enrollment or renewal of or in 43
Medicaid. In addition, the Department may not request authority to waive or decline to 44
periodically check any available income-related data sources to verify eligibility. 45
Unless required under federal law, the Department shall verify all conditions of eligibility for 46
Medicaid prior to enrollment and may not conduct post-enrollment verification without specific 47
authorization set forth in enactments by the General Assembly. 48
(b4) Public Housing. – Governmental public assistance entities shall take the steps with 49
respect to the sources listed in this subsection as follows: 50
(1) With respect to State databases: 51 General Assembly Of North Carolina Session 2025
Page 4 DRH30286-MC-165
a. On at least a monthly basis, public housing authorities shall enter into 1
a data matching agreement with the North Carolina State Lottery 2
Commission identifying individuals in households with lottery or 3
gambling winnings of three thousand dollars ($3,000) or more. 4
b. On at least a monthly basis, public housing authorities shall receive 5
and review information from the North Carolina Office of Vital 6
Records concerning individuals in households which receive housing 7
assistance that indicates a change in circumstances that may affect 8
eligibility for housing assistance, including, but not limited to, death 9
records. 10
c. On at least a quarterly basis, public housing authorities shall receive 11
and review information from the Department of Labor concerning 12
individuals in households which receive housing assistance that 13
indicates a change in circumstances that may affect eligibility for 14
housing assistance, including, but not limited to, changes in 15
employment or wages. 16
d. On at least a monthly basis, public housing authorities shall receive 17
and review information from the Department of Health and Human 18
Services concerning individuals in households which receive housing 19
assistance that indicates a change in circumstances that may affect 20
eligibility for housing assistance, including, but not limited to, 21
potential changes in residency as identified by out-of-state electronic 22
benefit transfer (EBT) card transactions. 23
e. On at least a quarterly basis, public housing authorities shall receive 24
and review information from the Department of Revenue concerning 25
individuals in households which receive housing assistance that 26
indicates a change in circumstances that may affect eligibility for 27
housing assistance, including, but not limited to, potential changes in 28
income, wages, or residency as identified by tax records. 29
f. On at least a monthly basis, public housing authorities shall receive 30
and review information from the Department of Adult Correction 31
concerning individuals in households which receive housing 32
assistance that indicates a change in circumstances that may affect 33
eligibility. 34
g. On at least a semimonthly basis, public housing authorities shall 35
receive and review information from the Department of Commerce 36
concerning individuals in households which receive housing 37
assistance that indicates a change in circumstances that may affect 38
eligibility for housing assistance, including, but not limited to, 39
potential changes in employment, income, or assets. 40
(2) With respect to federal databases, on at least a monthly basis, public housing 41
authorities shall review and act on findings affecting eligibility for public 42
housing assistance programs with respect to the information listed in 43
subdivision (b1)(2) of this section. 44
(3) At least once per year, each public housing authority shall submit a report to 45
the Attorney General detailing its child support cooperation requirement. Each 46
report must contain all of the following: 47
a. A list of departments the public housing authority has data sharing 48
agreements with. 49
b. A summary of the data received at each time interval required by this 50
subsection. 51 General Assembly Of North Carolina Session 2025
DRH30286-MC-165 Page 5
c. The number of individuals flagged for eligibility issues during each 1
quarterly or monthly review of the data. 2
d. The number of individuals removed from public housing assistance as 3
a result of issues flagged during the data review. 4
(4) The Attorney General shall determine and enforce compliance with the 5
provisions of this section. Any public housing authority that does not 6
implement the data checks required by this section shall be deemed to be out 7
of compliance with the requirements of this section. The Attorney General 8
shall publish an annual report detailing each public housing authority's 9
compliance from the previous year. The first instance in which the Attorney 10
General finds that a public housing authority is out of compliance with this 11
section, the public housing authority shall submit a corrective action plan to 12
implement the requirements under this section within 12 months. A second 13
finding of noncompliance that occurs more than eight years after the first 14
finding of noncompliance shall be treated as the first finding of 15
noncompliance. The second instance in which the Attorney General finds that 16
a public housing authority is out of compliance with this section, the public 17
housing authority shall have its charter under Chapter 157 of the General 18
Statutes revoked and cease to operate in this State. 19
(c) A county department of social services The Department of Health and Human 20
Services and public housing authorities shall promptly review the information provided or made 21
available by the Department in accordance with subsection (a) subsections (a) through (b4) of 22
this section to determine if the information indicates a change in circumstances that may affect a 23
medical public assistance beneficiary's eligibility to receive medical public assistance benefits 24
and take one of the following actions: 25
(1) If a review of the information does not result in the county department of 26
social services Department of Health and Human Services or public housing 27
authority finding a discrepancy or change in a beneficiary's circumstances that 28
may affect that beneficiary's eligibility to receive medical public assistance 29
benefits, the county department of social services Department of Health and 30
Human Services or public housing authority shall take no further action. 31
(2) If a review of the information does result in the county department of social 32
services Department of Health and Human Services or public housing 33
authority finding a discrepancy or change in a beneficiary's circumstances that 34
may affect that beneficiary's eligibility for medical public assistance benefits, 35
the county department of social services Department of Health and Human 36
Services or public housing authority shall provide written notice to the 37
beneficiary that describes in sufficient detail the circumstances of the 38
discrepancy or change in circumstances that would affect the beneficiary's 39
eligibility for medical public assistance benefits. The notice must include the 40
following information: 41
a. The beneficiary will have 12 calendar days from the time of mailing 42
to respond. 43
b. A response from the beneficiary must be in writing. 44
c. Self-declarations made by the beneficiary will not be accepted as 45
verification of information in the response. 46
d. The consequences of taking no action. 47
(d) After the expiration of 12 calendar days from the time of mailing the notice required 48
under subsection (c) of this section, the county department of social services Department of 49
Health and Human Services or public housing authority shall take one of the following 50 General Assembly Of North Carolina Session 2025
Page 6 DRH30286-MC-165
actions:actions within 60 days of receiving the public assistance beneficiary's written 1
disagreement: 2
(1) If a beneficiary did not respond to the notice, the county department of social 3
services Department of Health and Human Services or public housing 4
authority shall redetermine the beneficiary's eligibility for medical public 5
assistance benefits and provide the beneficiary with proper notice under 6
G.S. 108A-79. 7
(2) If a beneficiary responds to the notice and disagrees with the information in 8
the notice, the county department of social services Department of Health and 9
Human Services or public housing authority shall reinvestigate the matter and 10
take one of the following actions: 11
a. If the county department of social services Department of Health and 12
Human Services or public housing authority determines that there has 13
been an error and the beneficiary's eligibility to receive medical public 14
assistance benefits is not affected, then no further action shall be taken. 15
b. If the county department of social services Department of Health and 16
Human Services or public housing authority determines that there is 17
no error, the county department of social services Department of 18
Health and Human Services or public housing authority shall 19
redetermine the beneficiary's eligibility for medical public assistance 20
benefits and provide the beneficiary with proper notice under 21
G.S. 108A-79. 22
(3) If a beneficiary responds to the notice and confirms the information in the 23
notice is correct, then the county department of social services Department of 24
Health and Human Services or public housing authority shall redetermine the 25
beneficiary's eligibility for medical public assistance benefits and provide the 26
beneficiary with proper notice under G.S. 108A-79. 27
If, at any time after receiving a beneficiary's response to the notice, the county department of 28
social services Department of Health and Human Services or public housing authority determines 29
that there is a risk of fraud or misrepresentation or inadequate documentation, then the county 30
department of social services may request additional documentation from the beneficiary. 31
(e) Nothing in this section shall preclude the Department or any county department of 32
social services public housing authority from receiving or reviewing additional information 33
related to a beneficiary's eligibility for medical public assistance benefits that is obtained in a 34
manner other than that provided for under this section. 35
(f) The Department of Health and Human Services and public housing authorities shall 36
have the authority to execute a memorandum of understanding with any department, agency, or 37
division for information required to be shared between agencies outlined in this section. 38
(g) Nothing in this section shall prohibit the Department of Health and Human Services 39
or a public housing authority from contracting with one or more independent vendors to provide 40
additional data or information which may indicate a change in circumstances that may affect 41
eligibility. 42
(h) The Department of Health and Human Services shall promulgate all rules and 43
regulations necessary for the purposes of carrying out this section." 44
SECTION 2. This act becomes effective January 1, 2026. 45