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CMS Oversight of States' Preparation of the CMS-64 Report

Announced on  | Last Modified on  | Project Number: A-06-23-09006
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The Medicaid program provides medical assistance to low-income individuals and individuals with disabilities. The Federal and State governments jointly fund and administer the Medicaid program. At the Federal level, CMS administers the program. The Federal Government pays its share of a State's Medicaid expenditures based on the Federal Medical Assistance Percentage, which varies depending on the State's relative per capita income. Within 30 days after the end of each quarter, States report expenditures and the associated Federal share on the CMS-64 report. The amounts that States report must represent actual expenditures. CMS is responsible for reviewing the CMS-64 report to ensure that the expenditures reported are consistent with Medicaid requirements and matched with the correct amount of Federal funds. CMS works with States to resolve any questionable expenditures. We will determine the effectiveness of CMS's oversight of Medicaid State expenditures reported on CMS-64 reports for the quarter ended September 30, 2022.

TIMELINE

REPORT PUBLISHED

CMS Should Improve Its Policies and Procedures for the Oversight of States’ Reported Medicaid Expenditures to Better Protect the Financial Integrity of the Medicaid Program (A-06-23-09006)

  • CMS did not consistently follow its policies and procedures related to the oversight of Medicaid State expenditures reported on the CMS-64. Specifically, CMS’s quarterly review work papers for five selected States that we reviewed were not always clear, accurate, or consistent enough to validate that its analysts thoroughly completed all procedures outlined in its Review Guide.
  • CMS’s policies and procedures related to deferred expenditures did not adhere to the timely resolution timelines set forth in Federal regulations, resulting in deferred payments remaining unresolved for years.
  • CMS’s policies and procedures related to tracking of disallowed expenditures need improvement to allow for more accessible and accurate reporting of disallowed payment information.

26-A-06-068.01 to CMS - Open Unimplemented
Update expected on 12/02/2026
We recommend that CMS develop and implement additional training for analysts to improve the clarity, accuracy, and consistency of their documentation for reviewing CMS-64s.

26-A-06-068.02 to CMS - Open Unimplemented
Update expected on 12/02/2026
We recommend that CMS revise its policies and procedures related to deferred payments to align the deferral resolution timelines with Federal regulations.

26-A-06-068.03 to CMS - Open Unimplemented
Update expected on 12/02/2026
We recommend that CMS modify its policies and procedures to specify which CMS departments are responsible for tracking and resolving disallowed payments.

26-A-06-068.04 to CMS - Open Unimplemented
Update expected on 12/02/2026
We recommend that CMS modify its Review Guide to include a step that requires analysts to determine the status of disallowed payments.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Departmental Operational Issues Financial Stewardship
Target Groups
-
Financial Groups
Medicaid