Sneak Preview: CMS To Issue Guidance on Medicaid Interstate Match

September 3, 2014 | By Jerry Ashworth | Post a Comment

xgran_bookshot(The following was excerpted from an article in the Federal Grants Management Handbook.) The Centers for Medicare and Medicaid Services plans to issue guidance to states explaining their responsibilities for participating in the Medicaid Interstate Match in response to a recent recommendation by the Department of Health and Human Services Office of Inspector General.

CMS estimated that about 5.8 percent, or $14.4 billion, of Medicaid payments made in fiscal year 2013 were improper, more than half of which were due to eligibility errors. One type of eligibility error occurs when beneficiaries remain enrolled in a state’s Medicaid program after they have become ineligible because they are no longer residents of the state or have failed to report a change of address.

CMS created the Public Assistance Reporting Information System (PARIS) Medicaid Interstate Match as a key tool to help reduce improper payments by identifying beneficiaries who are enrolled in multiple state Medicaid programs. States submit Medicaid enrollment data to the Defense Manpower Data Center, which compares Social Security Numbers of enrolled beneficiaries from one state another to develop its quarterly matching report.

After state Medicaid agencies receive their match information from DMDC, states must verify the matches to determine whether beneficiaries are still eligible to receive benefits in their state. If a state verifies a match and determines that a beneficiary is ineligible to receive Medicaid, it may act to discontinue benefits.

Even though CMS requires state participation in the Medicaid Interstate Match as a condition of receiving Medicaid funding, OIG found that state participation was limited. While all states in August 2011 submitted enrollment data, OIG found that 14 states did not submit enrollment data for all of their beneficiaries. For example, one state did not submit enrollment data for 79 percent of its Medicaid beneficiaries. “To maximize the potential for the Medicaid Interstate Match to identify beneficiaries who may be enrolled in multiple state Medicaid programs, each state needs to submit complete enrollment data for all of its beneficiaries,” OIG added. State officials explained that they did not submit complete enrollment data because they lacked staff to prepare the submission or because their state systems were not compatible with the DMDC system.

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