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CMS to Increase Oversight of Medicaid Enrollment, Managed Care Plans

The Centers for Medicare and Medicaid Services (CMS) is ratcheting up scrutiny of state Medicaid programs. The agency announced Tuesday that it is boosting audits to confirm that Medicaid beneficiaries are correctly identified as expansion or pre-expansion enrollees. States receive higher federal match rates of around 90 percent for expansion enrollees, while the match rate can be as low as 50 percent for pre-expansion enrollees. "This imbalance in the federal matching rate creates financial risks for taxpayers by incentivizing states to shift cost to the federal government," CMS Administrator Seema Verma told reporters Tuesday. "This requires us to make sure that states are making accurate eligibility determinations."  The CMS also said it will audit states found by the Department of Health and Human Services' Office of Inspector General (OIG) to be at high risk for enrolling ineligible people in Medicaid. California, Kentucky, and New York have been cited by the OIG for doing this in the past. (Virgil Dickson, Modern Healthcare)

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