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‘Historic fiscal crisis’

By M.D. Kittle

MADISON — Of all the wasteful federal government programs, Medicaid takes the cake.

The government-run health insurance program made $57.36 billion in improper payments in fiscal year 2019, according to the Centers for Medicare & Medicaid Services. That represented about 33 percent of improper payments across the federal government, according to federal records. In fiscal year 2020, improper payments climbed to $86.9 billion, meaning more than one out of every five Medicaid payments were improper. Error rates in some states are running as high as 50 percent, according to a recent report.

U.S. Sen. Ron Johnson (R-Oshkosh) wants to know what kind of operation CMS is running.

Johnson and U.S. Rep. James Comer (R-Ky.), Ranking Member of the House Committee on Oversight, recently joined 20 of their colleagues in sending a letter to CMS Administrator Chiquita Brooks-LaSure seeking information on what safeguards CMS has in place to address improper payments in the Medicaid program.

‫”These staggering rates of improper payments in Medicaid programs are inexcusable. As CMS data underscores, these improper payments threaten the integrity of the Medicaid program,” the members wrote.

“Moreover, we are concerned the policies implemented in response to the COVID-19 pandemic—expanded Medicaid eligibility, increased federal funding and suspended state audits—possibly added to the significant levels of improper payments in the program.”

A recent report by the Foundation for Government Accountability found almost all of the improper payments were due to eligibility errors, administrative oversights, or outright fraud. Further, the report found the rate of Medicaid improper payments has nearly quadrupled since the implementation of Obamacare in 2014.”

“Over time, Medicaid has transformed from a program for the truly needy into a massive welfare program for millions of able-bodied adults,” the foundation stated.  “As Medicaid has grown, so has its mismanagement.”

All of these troubling numbers surround a Medicaid program whose trust fund is projected to be involvement beginning in 2026.

The situation was exacerbated during the pandemic, with implementation of Medicaid policies in the Families First Coronavirus Relief Act (FFCRA)  which has kept 17 million ineligible enrollees on the program.

Medicaid enrollment has soared to new record highs, reaching an estimated 91 million by December 2021, according to a FGA report, “The Medicaid crisis is here: How congressional handcuffs are causing Medicaid to implode.” Nearly 90 percent of Medicaid enrollment growth has been driven by individuals who are ineligible for the program

“The Medicaid policies in FFCRA made these program integrity issues even worse, handcuffing states from removing ineligible enrollees from the program so long as they accept additional COVID-19 relief funding. These handcuffs have kept 17 million ineligible enrollees on the program, costing taxpayers billions of dollars and crowding out resources for the truly needy,” the foundation reports.

In their letter to CMS, the lawmakers, including U.S. Rep Glenn Grothman of Wisconsin’s 6th Congressional District, ask CMS to provide the following information:

  1. The underlying data and methodology used to determine improper payment rates for all 50 states and the District of Columbia, including the eligibility component of the rate, for each year.
  2. The processes and procedures CMS uses to validate each state’s improper payment rate. This includes sample data sets used by states or CMS to review eligibility determinations.
  3. A list of CMS’s efforts to recover the hundreds of billions of dollars in improper Medicaid payments.
  4. The estimated improper payment rate due to the Medicaid expansion in response to COVID-19 and the number of Americans newly enrolled in the Medicaid program in response to COVID-19.
  5. The actions taken by CMS to date to ensure the program only enrolls those who meet eligibility requirements. Please provide this information on a state-by-state basis.

“According to their own data, the Centers for Medicare and Medicaid Services (CMS) is wasting a staggering amount of taxpayer money each and every year by making improper payments,” said Garrett Bess, Vice President of Heritage Action. “This cavalier attitude towards public finances is why America faces a historic fiscal crisis.”

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