WASHINGTON, DC - House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Health Subcommittee Chairman Joseph Pitts (R-PA) recently sent a letter to Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) following up on a recent hearing that reviewed Obamacare exchanges and Medicaid eligibility determinations. The committee leaders explained they were, “following up on concerning findings from an October 23rd Subcommittee on Health hearing that reviewed the inaccuracy of Medicaid and exchange eligibility determinations. 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."
The hearing raised key questions about how CMS’s lack of oversight may put low-income consumers at risk for higher costs or challenges in accessing care. In testimony before the subcommittee, the nonpartisan watchdog Government Accountability Office (GAO) warned, “Careful CMS oversight is crucial to ensure that determinations of Medicaid eligibility are appropriate, and that the risk of coverage gaps and duplicate coverage is minimized for individuals transitioning between the coverage types."
Whether or not CMS is making accurate determinations for the Exchanges and Medicaid not only impacts millions of people, it implicates billions of dollars. The leaders noted, “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."
With open enrollment ongoing, the leaders expressed alarm at the systemic vulnerabilities that currently remain with CMS’s eligibility determinations. They noted that “GAO did not find any improvements in the federal exchange’s control environment for plan year 2015" and “GAO also found vulnerabilities in the State marketplace similar to the federal exchanges." Additionally, the committee leaders expressed dismay that “CMS does not have a process in place to ensure that states are claiming the appropriate federal matching rate for Medicaid beneficiary expenditures."
Upton and Pitts have requested answers to a number of important questions to assess whether CMS has taken sufficient steps to protect consumers and taxpayers during this third open enrollment period. The committee leaders warned that GAO’s testimony suggests CMS is prioritizing boosting enrollment numbers over ensuring the basic integrity of the program.
Read a copy of the letter her e.
