The tool — the Public Assistance Information Reporting System Medicaid Interstate Match — has the potential to reduce improper payments by identifying people enrolled in multiple state Medicaid programs. In 2013, eligibility errors resulted in approximately 57 percent in improper Medicaid payments, leading to about $8.2 billion in federal spending. Beneficiaries remaining enrolled in a state’s Medicaid program when they are no longer residents of the state is one scenario that leads to eligibility errors, according to the OIG.
The Social Security Act requires states to participate in the Medicaid Interstate Match. However, neither the SSA nor CMS have defined the specific meaning of participation. The OIG analyzed information from a random sample of 300 matches from the August 2011 match, conducted interviews with CMS officials concerning guidance from the agency and surveyed state Medicaid agencies. According to the OIG, participation in the match program involves submitting Medicaid enrollment data, verifying matches, discontinuing Medicaid benefits for ineligible individuals and recovering any improper payments.
The OIG found state match participation was limited in 2011. For instance, 14 states didn’t submit Medicaid enrollment data for all beneficiaries in their state. Furthermore, states didn’t verify almost 70 percent of the matches because of issues with the enrollment data, and less than half of the verified matches led to discontinuation of beneficiaries’ benefits, according to the report. Finally, the states didn’t recover any improper Medicaid payments.
Therefore, the OIG recommended that CMS issue additional guidance on match participation, including clarification about submitting enrollment data, verifying matches, discontinuing benefits and recovering improper payments. CMS has concurred with the recommendation, according to the report.
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