Improper Medicaid payments for fiscal year 2019 are estimated at $57.36 billion, a 14.9% rate, the Centers for Medicare & Medicaid Services said Monday.
The amount is an increase from $36.2 billion in fiscal year 2018 (a 9.79% rate), but CMS said data for the two years are not comparable due to changes in the way the agency calculates the measurements. Improper payments now are calculated using the Payment Error Rate Measurement, or PERM, program, which was “paused” from FY 2014 to FY 2018 as states were implementing new rules under the Affordable Care Act, CMS said.
Under the PERM program, error rates in 17 states are measured each year until, over a three-year period, error rates in all states have been measured. “CMS expects to see a steady increase in eligibility vulnerabilities identified over the next two years once all three PERM cycles are measured under the updated eligibility component,” the agency said in a press release.
Most errors, CMS said, are related to states maintaining insufficient eligibility documentation, not conducting timely and appropriate annual redeterminations, and claiming beneficiaries under incorrect eligibility categories that provide a higher federal matching rate. “Eligibility errors of this nature are particularly concerning as it can indicate that individuals are allowed to remain enrolled in the program during times in which they do not qualify, potentially diverting limited resources that could otherwise be invested in better serving vulnerable populations,” the agency.
“CMS will build on our previous guidance on eligibility by overhauling our regulations to tighten the standards for eligibility verification and ensure that CMS and states have appropriate safeguards in place,” CMS Administrator Seema Verma told the National Association of Medicaid Directors last week.
According to the National Center for Assisted Living, approximately 16.5% of assisted living residents rely on Medicaid to cover their assisted living services.
