Series: Review of State Uncompensated Care Pools

OBJECTIVE

Some State Medicaid agencies operate uncompensated care pools (UCPs) under waivers approved by CMS. Section 1115 of Title XIX of the Social Security Act gives CMS authority to approve experimental, pilot, or demonstration projects that it considers likely to help promote the objectives of the Medicaid program. The purpose of these projects, which give States additional flexibility to design and improve their programs, is to demonstrate and evaluate State-specific policy approaches to better serve Medicaid populations. To implement a State demonstration project, States must comply with the special terms and conditions (STCs) of the agreement between CMS and the State. The purpose of the UCPs is to pay providers for uncompensated cost incurred in caring for low-income (Medicaid and uninsured) patients. Through UCPs, States pay out hundreds of millions of dollars to providers and receive Federal financial participation. However, in some States there has previously been little oversight of the payments. We will determine whether selected States' Medicaid agencies made payments to hospitals under the UCPs that were in accordance with the STCs of the waiver and with applicable Federal regulations.

There are 2 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (1)

COMPLETED PROJECTS IN THIS SERIES (1)

Massachusetts

Project A-04-22-04091 • Completed on February 19, 2025

TIMELINE

• December 1, 2020
  Series Number W-00-24-31537 Assigned
• December 1, 2020
  Project Announced

  Project A-07-21-07001

• June 6, 2022
  Project Announced

  Massachusetts - A-04-22-04091

• February 19, 2025
  Project Complete - A-04-22-04091

  Massachusetts has been marked as complete. This audit resulted in 5 recommendations.

• Today
  1 Audit In-Progress
• Est FY2026
  Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

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