Lawmakers express alarm over Medicaid exchange eligibility determinations
To address those concerns, the two lawmakers penned a letter to Andy Slavitt, acting administrator of Centers for Medicare and Medicaid Services (CMS).
"We are very concerned that the lack of meaningful eligibility controls in Medicaid and the exchanges established under the Affordable Care Act (ACA) puts American tax dollars at risk," they said in the letter.
Upton and Pitts also said low-income consumers could be negatively impacted by lack of controls with regard to Medicaid eligibility.
"Whether or not CMS is making accurate determinations for the exchanges and Medicaid not only impacts millions of people -- it implicates billions of dollars," they said. "According to the Congressional Budget Office, the estimated cost of subsidies and related spending under the ACA between fiscal years 2016 and 2025 is nearly $850 billion. Federal expenditures for the Medicaid expansion are estimated by the CMS Office of the Actuary to be $430 billion from 2014 through 2023. With the enormous costs of these programs, it is vital to ensure that American tax dollars are being spent appropriately.”
As ACA open enrollment continues, Pitts and Upton said any eligibility determination gaffes would move forward with it.
"CMS does not have a process in place to ensure that states are claiming the appropriate federal matching rate for Medicaid beneficiary expenditures," they said in the letter.
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U.S. House Committee on Energy and Commerce 2125 Rayburn House Office Building Washington, DC - 20515