Health Law Matters

CMS Issues Guidance on Vetting Medicaid Eligibility

The Week In Health Law

  • The Centers for Medicare and Medicaid Services (“CMS”) issued guidance to state Medicaid agencies outlining necessary assurances states should make to ensure  program resources are reserved for those who meet Medicaid eligibility requirements. CMS indicates the guidance is part of an effort to reduce improper Medicaid payments while enhancing the financial and programmatic integrity of the program.
  • The guidance was motivated in significant part by the swelling of Medicaid enrollment across all states in the wake of expansion under the Patient Protection and Affordable Care Act, as CMS indicates more than 15 million new working-age, adult enrollees have been added to Medicaid in the last five years. The guidance emphasizes CMS’s expectations for states that have implemented Medicaid expansion, and also includes a checklist states can use to monitor eligibility criteria and payment compliance.
  • “We have seen a rapid increase in Medicaid spending in recent years and with this growth comes an increasing and urgent responsibility to ensure sound stewardship and oversight of our program resources,” said CMS Administrator Seema Verma in a statement. “We are taking a strategic approach to managing improper payments, risks, and fraud as well as developing effective program integrity controls to ensure that government services aid their intended purposes.”

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Thomas D. Anthony is the former chair of FBT's Health Care Industry Team. He focuses on counseling health care entities on corporate transactions, regulatory compliance and joint ventures.