E&C Leaders Press Health Department Watchdog for Information about Outdated and Incorrect Medicaid Enrollment
Washington, D.C. — House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Subcommittee Republicans, today sent a letter to Department of Health and Human Services (HHS) Inspector General (IG) Christi Grimm. The letter highlights concerns surrounding improper Medicaid payments and challenges States face in maintaining accurate enrollment during and after the eligibility redetermination process.
“It is critical that CMS and States take action to reduce the number of improper Medicaid payments to ensure that taxpayer dollars are spent to care for the most vulnerable who Medicaid was designed to help,” Chairs Rodgers, Guthrie, and Griffith wrote.
- In response to the COVID-19 pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA), which included provisions for enhanced Federal Medical Assistance Percentage (FMAP) of 6.2% for States and required continuous Medicaid coverage through the COVID-19 Public Health Emergency (PHE).
- The PHE led to a surge in Medicaid enrollment, increasing from 70 million to nearly 95 million individuals.
- As part of the 2023 Consolidated Appropriations Act, States are authorized to start the process of redetermining Medicaid eligibility from April 1, 2023.
- Research demonstrates that even before the COVID-19 pandemic, maintaining accurate Medicaid enrollment posed a significant challenge for CMS.
- Past audits from the HHS IG have found inaccuracies in Medicaid enrollment resulted in improper payments.
The Chairs requested a briefing from the Office of the Inspector General as well as an audit that reviews and analyzes the following information regarding ineligible beneficiaries:
- The reason for beneficiaries’ ineligibility
- The types of factors and information considered at the time of enrollment
- The causes of incorrect eligibility determinations
- The approximate time individuals were ineligibly enrolled
- The approximate dollar amount spent on recipients who were ineligible
- The approximate dollar amount delivered to insurance companies on behalf of ineligible enrollees
CLICK HERE to read the letter to HHS IG Grimm.