Almost all states had compliance issues with Medicaid redetermination requirements for returning to normal operations following the COVID-19 public health emergency, the Government Accountability Office (GAO) reviews in a July 18 report.
Beginning in April 2023, states resumed full eligibility redeterminations after the end of the Medicaid continuous enrollment requirement. The Centers for Medicare and Medicaid Services (CMS) placed additional redetermination requirements on states to ensure eligible Medicaid beneficiaries did not lose coverage during the return to normal Medicaid operations.
Compliance issues included not conducting ex parte reviews at the individual level or for certain populations, not allowing enrollees to submit renewal forms through all modalities, and issues with long-standing requirements.
As of April 2024, CMS and states had resolved some compliance issues and taken steps to resolve others. CMS plans to incorporate lessons learned from this process in its oversight approach.
In “Medicaid: Federal Oversight of State Eligibility Redeterminations Should Reflect Lessons Learned after COVID-19,” GAO recommends that CMS document and implement that the oversight practices the agency learned during unwinding were necessary for preventing and detecting state compliance issues with redetermination requirements.
CMS agreed with GAO’s recommendation and noted that work was underway to address it.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
Author