December 08,2015

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Hatch and Upton Press CMS On Lack of Oversight of Medicaid Verification Systems

Improper Payments for Medicaid Near 10 Percent - States Have Fallen Woefully Behind Implementing Verification Systems to Cut Down On Improper Payments

WASHINGTON, DC – As part of ongoing bicameral collaboration to protect Medicaid services for the most vulnerable, Senate Finance Committee Chairman Orrin Hatch (R-UT) and House Energy and Commerce Committee Chairman Fred Upton (R-MI) sent a letter to Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS). The leaders are concerned with the agency’s apparent lack of oversight of states’ implementation of electronic asset verification systems for aged, blind, and disabled populations under Medicaid.

The leaders wrote, “Without targeted CMS oversight, states may not be using required mechanisms to ensure the accuracy of Medicaid eligibility determinations, thereby placing American taxpayer dollars at risk.”

Upton and Hatch continued, “There is good reason to be concerned about the need to further protect taxpayer dollars in Medicaid. According to the Agency Financial Report released by the U.S. Department of Health and Human Services (HHS) on November 16th, in fiscal year 2015, the Medicaid improper payment rate was 9.78 percent overall, and 10.59 percent in fee-for-service Medicaid.”

The bicameral leaders cite a 2008 law requiring states to implement electronic asset verification systems to verify the assets of aged, blind, and disabled Medicaid applicants. The law specified that states implement these systems on a rolling basis. Based on CMS guidance for implementing the law, and by the end of fiscal year 2011, 25 states should have implemented their electronic asset verification systems.

However, the nonpartisan Government Accountability Office (GAO) reported that no states had implemented such a program as of November 2011. Even more troubling, a May 2014 GAO report indicated that only two of 12 states that had been interviewed reported having such a system in place, despite the fact that all states were supposed to have implemented one by the end of fiscal year 2013.

The leaders are pressing CMS to provide status updates for each state’s electronic asset verification systems’ implementation, and answers to questions about the extent to which the applicants’ assets are verified for the systems already in place.

Read the full letter online here.