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Series: States' Medicaid Eligibility and Enrollment Actions Concluding the COVID-19 Public Health Emergency

Announced on  | Last Modified on  | Series Number: W-00-24-31567
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

In response to the COVID-19 pandemic, section 6008 of the Families First Coronavirus Response Act (FFCRA) provides a temporary increase of 6.2 percentage points to each qualifying State's and Territory's Federal Medical Assistance Percentage (FMAP), effective January 1, 2020. To receive the increased FMAP, FFCRA requires States to provide benefits to individuals who were enrolled in Medicaid at the start of the COVID-19 public health emergency (PHE) or become enrolled in Medicaid during the emergency period. These individuals should remain eligible for Medicaid through the last day of the month in which the COVID-19 PHE ends (continuous enrollment period), unless the individual requests a voluntary termination of eligibility, or the individual ceases to be a resident of the State. Within the 12-month period in which the COVID-19 PHE ends, States must initiate all renewals, post-enrollment verifications, and redeterminations for all individuals enrolled when the continuous enrollment expires. At the conclusion of the COVID-19 PHE, we will review the States' required Medicaid eligibility and enrollment actions. We will determine whether States completed pending Medicaid eligibility and enrollment actions in accordance with CMS requirements that take effect after the COVID-19 PHE.

There are 4 projects in this series.

COMPLETED PROJECTS IN THIS SERIES (4)

Utah

Project A-07-24-07013 • Completed on August 27, 2024

Massachusetts

Project A-02-24-01001 • Completed on August 13, 2024

California

Project A-09-24-02001 • Completed on May 7, 2024

Ohio

Project A-05-23-00019 • Completed on April 9, 2024

TIMELINE

  • August 9, 2023
    Series Number W-00-24-31567 Assigned
  • August 9, 2023
    Project Announced

    Ohio - A-05-23-00019

  • October 5, 2023
    Project Announced

    Utah - A-07-24-07013

  • October 10, 2023
    Projects Announced

    Massachusetts - A-02-24-01001

  • California - A-09-24-02001

  • April 9, 2024
    Project Complete - A-05-23-00019

    Ohio has been marked as complete. This audit resulted in 3 recommendations.

  • May 7, 2024
    Project Complete - A-09-24-02001

    California has been marked as complete. This audit resulted in 4 recommendations.

  • August 13, 2024
    Project Complete - A-02-24-01001

    Massachusetts has been marked as complete. This audit resulted in 3 recommendations.

  • August 27, 2024
    Project Complete - A-07-24-07013

    Utah has been marked as complete. This audit resulted in 4 recommendations.

  • August 27, 2024
    Series Complete

    States' Medicaid Eligibility and Enrollment Actions Concluding the COVID-19 Public Health Emergency has been marked as complete.

4 REPORT PUBLISHED

Massachusetts Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-02-24-01001)

24-A-02-096.01 to CMS - Closed Implemented
Closed on 12/13/2024
We recommend that the Massachusetts' Executive Office of Health and Human Services redetermine eligibility for the three sampled enrollees whose eligibility was incorrectly determined and take appropriate action.

24-A-02-096.02 to CMS - Closed Implemented
Closed on 12/13/2024
We recommend that the Massachusetts' Executive Office of Health and Human Services provide periodic training to caseworkers about verifying and documenting enrollees' income and residency during the renewal process.

24-A-02-096.03 to CMS - Closed Implemented
Closed on 12/13/2024
We recommend that the Massachusetts' Executive Office of Health and Human Services revise policies and procedures to be consistent with CMS guidance related to preparing unwinding data reports and any future reports of a similar nature.

View in Recommendation Tracker

Ohio Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-05-23-00019)

24-A-05-066.01 to CMS - Closed Implemented
Closed on 05/30/2024
We recommend that the Ohio Department of Medicaid take appropriate action with respect to the incorrect Medicaid eligibility determinations identified in our sample.

24-A-05-066.02 to CMS - Closed Implemented
Closed on 02/21/2025
We recommend that the Ohio Department of Medicaid provide periodic training to caseworkers about verifying and documenting enrollees' income during the renewal process.

24-A-05-066.03 to CMS - Closed Implemented
Closed on 02/21/2025
We recommend that the Ohio Department of Medicaid provide additional training to caseworkers about using current information when conducting enrollee eligibility determinations.

View in Recommendation Tracker

Utah Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-07-24-07013)

24-A-07-100.01 to CMS - Closed Implemented
Closed on 11/27/2024
We recommend that the Utah Department of Health and Human Services redetermine Medicaid eligibility for the six sampled enrollees whom we have identified as having had incorrectly completed eligibility determinations.

24-A-07-100.02 to CMS - Closed Implemented
Closed on 03/27/2025
We recommend that the Utah Department of Health and Human Services coordinate with DWS to provide periodic training to caseworkers that focuses on verifying and documenting information used and steps performed during the eligibility renewal process, including: (1) verifying income and assets, (2) verifying residency/contact information, and (3) correctly executing case review and reporting.

24-A-07-100.03 to CMS - Closed Implemented
Closed on 11/27/2024
We recommend that the Utah Department of Health and Human Services identify and correct the eREP data limitations, which in some cases prevented proper reporting classification.

24-A-07-100.04 to CMS - Closed Implemented
Closed on 11/27/2024
We recommend that the Utah Department of Health and Human Services strengthen its policies and procedures to provide for greater accuracy in the monthly unwinding data reports and any future reports of a similar nature that the State agency submits to CMS.

View in Recommendation Tracker

California Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-09-24-02001)

24-A-09-070.01 to CMS - Closed Implemented
Closed on 04/22/2025
We recommend that the California Department of Health Care Services redetermine eligibility for the nine sampled enrollees whose eligibility was incorrectly determined and the five sampled enrollees whose eligibility may have been incorrectly determined.

24-A-09-070.02 to CMS - Closed Implemented
Closed on 04/07/2025
We recommend that the California Department of Health Care Services provide caseworkers additional training to reduce errors related to: (1) calculating and verifying income, (2) entering income information into the county case management system, and (3) using electronic data sources when verifying enrollees' reported income.

24-A-09-070.03 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services revise its guidance to instruct counties to document in case files essential information to support enrollees' continuing eligibility, including: (1) attempts to review enrollees' eligibility on a manual ex parte basis and (2) income and household information provided by the enrollee in person.

24-A-09-070.04 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services identify and correct the system issues that prevented the State agency from renewing enrollees' eligibility on an ex parte basis when those enrollees should have been determined eligible and from sending a notice of termination to enrollees.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
COVID-19 Departmental Operational Issues
Target Groups
-
Financial Groups
Medicaid