CMS Issues Informational Bulletin on Enforcing Medicaid Program Eligibility Requirements

ANCOR is sharing this informational bulletin by the Centers for Medicare and Medicaid Services (CMS) because the majority of supports for people with intellectual / developmental disabilities are funded by Medicaid, and this guidance would include disability supports.

As described by CMS, this bulletin “outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements”. The first and second pages of the bulletin state that the document focuses specifically on:

“1. Development of necessary program integrity protections,

2. Implementation of appropriate system and financial oversight controls,

3. Monitoring the program effectively, and;

4. Documentation and evidence to support these activities.”

Readers might also be interested in the program readiness checklist states are instructed to use to prepare for audits and review, among other functions. The checklist is available on pages 3-5 of the bulletin and focuses on:

• Ensuring accurate eligibility determinations;
• Claiming appropriate FFP or FMAP match rates;
• Program oversight;
• Use of additional program integrity tools and;
• Financing.

Relevant, Don’t Miss Resource: Readers seeking greater background information on this topic might also be interested in a 50-state survey released by the Kaiser Family Foundation (KFF) on this topic, which “presents state-level data and tables on Medicaid financial eligibility criteria and adoption of the major coverage pathways related to old age and disability as of 2018.”