Sneak Preview: GAO Calls for Accurate Medicaid Determinations

(The following was excerpted from a recent article in the Federal Grants Management Handbook.) The Government Accountability Office (GAO), in a recent report to Congress, noted that federal efforts to address improper Medicaid payments made due to eligibility determination errors by states could be enhanced if officials with the Centers for Medicare and Medicaid Services (CMS) coordinated their oversight responsibilities with information from state auditors.

In federal fiscal year (FY) 2018, Medicaid covered about 75 million individuals nationwide at an estimated cost of $629 billion. To determine whether individuals are eligible for Medicaid, state Medicaid agencies review certain criteria including financial and citizenship requirements, and evaluate and enroll individuals according to a “basis of eligibility” (e.g., low-income pregnant woman; blind or disabled individual; caretaker, etc.). Ultimately, each state’s Medicaid plan will outline the services the state will provide, the populations covered by their program, and how the state will implement and comply with other federal requirements.

In 2014, CMS, which oversees states’ Medicaid eligibility determinations, issued a framework based on federal rules for states to use in developing their systems to assess individuals’ bases of eligibility. CMS also had long-standing programs to: (1) monitor the accuracy and timeliness of Medicaid eligibility determinations to avoid inappropriate payments and eligibility decision delays, and (2) calculate the Medicaid improper payment rate. However, GAO found that CMS did not publish an updated national Medicaid eligibility improper payment rate from 2015 through 2018 as states implemented the Patient Protection and Affordable Care Act of 2014 (Pub. L. 111-148), as amended, which made changes to the Medicaid eligibility rules by providing states the option to expand eligibility to certain nonelderly adults.

(The full version of this story has now been made available to all for a limited time here.)

Join us for our following Federal Grants Forums:
Federal Grants Forum: Portland, OR | May 13 – 15, 2020
Federal Grants Forum: Chicago, IL | August 12 – 14, 2020
Federal Grants Forum: Denver, CO | October 7 – 9, 2020

Learn more at http://grants.thompson.com/conferences.aspx.