Public Assistance Reporting Information System: State Participation in the Medicaid Interstate Match is Limited
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WHY WE DID THIS STUDY
In 2013, eligibility errors caused an estimated 57 percent of improper Medicaid payments, representing approximately $8.2 billion in Federal expenditures. One type of eligibility error occurs when beneficiaries remain enrolled in a State's Medicaid program for which they are ineligible because they are no longer residents of the State and/or have failed to timely report a change in circumstances (i.e., address and residency) to the State. The Public Assistance Information Reporting System (PARIS) Medicaid Interstate Match is an important tool that has the potential to reduce improper Medicaid payments by identifying beneficiaries who are enrolled in multiple State Medicaid programs. Although the Social Security Act (SSA) mandates that States participate in the match, neither the SSA nor guidance from CMS defines the meaning of such participation.
HOW WE DID THIS STUDY
We discuss "participation" in the Medicaid Interstate Match as four steps that States perform to reduce improper payments: (1) submitting Medicaid enrollment data, (2) verifying matches, (3) discontinuing Medicaid benefits for ineligible beneficiaries, and (4) recovering any improper Medicaid payments. To determine the extent to which States participate in the match, we gathered information from States for a random sample of 300 matches from the August 2011 match. We conducted structured interviews with officials from CMS to determine the extent to which they provided guidance to States on the four steps. Finally, we conducted a survey of State Medicaid agencies and collected their match policies to determine the extent to which States have policies on the four steps.
WHAT WE FOUND
States' participation in the Medicaid Interstate Match is limited. CMS guidance to States for participating in the match is limited, and States reported that they needed more guidance. Most States had policies addressing at least one of the steps for participating in the match.
WHAT WE RECOMMEND
We recommend that CMS issue guidance to States on the requirement for participating in the Medicaid Interstate Match. CMS concurred with our recommendation.
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Priority recommendations summarized.
FY 2016 Work Plan
OIG projects planned for 2016.
Significant OIG activities in 6-month increments.