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CMS Plans Closer Scrutiny of Medicaid Eligibility, Financing

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CMS Plans Closer Scrutiny of Medicaid Eligibility, Financing

Monday, November 4, 2019
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With the majority of disability supports in the U.S. funded by Medicaid, we are closely following news that CMS is seeking to issue rules this fall on how states determine who is eligible for the program and how it is financed. As reported by Politico Pro:

“Federal health officials are planning a rule focused on how states determine who is eligible for Medicaid, according to five sources with knowledge of the proposal. The effort follows concern from Trump officials that states are improperly classifying certain Medicaid beneficiaries as ACA expansion enrollees and getting more federal funds than allowed.

A separate regulation would aim to make more transparent how states finance their Medicaid programs and their use of supplemental payments, which help them draw down more federal funding, sources said. States frequently make additional payments to hospitals and other health care providers on top of reimbursement they receive for medical services, and those dollars are matched by the federal government. Lawmakers and nonpartisan experts have voiced concern that lax oversight of these arrangements has led to significant overspending.

CMS could issue the rules as early as this fall, two sources said. CMS declined to comment on potential plans for rulemaking.

CMS Administrator Seema Verma discussed the initiatives with aides to several governors during a private White House meeting in late October, framing them as an effort to protect Medicaid program integrity, according to two people who were either in the room or briefed on the comments.”