The Centers for Medicare & Medicaid Services (CMS) is implementing measures to enhance the integrity of Medicaid and the Children’s Health Insurance Program (CHIP). The agency has issued new letters to states, indicating a shift away from policies that exceed statutory limits, particularly concerning continuous eligibility and workforce initiatives. This move underscores CMS's commitment to maintaining these programs for vulnerable Americans while ensuring prudent use of taxpayer funds.
Expanded continuous eligibility allows individuals to remain on Medicaid even if they no longer qualify, potentially leading to states overpaying for ineligible coverage. Workforce initiatives aimed at strengthening services through primary care, behavioral health, dental, and home-based services also require significant federal investment.
"For too long, Medicaid and CHIP have drifted away from their core mission of providing a safety net for the truly vulnerable—that ends now," said CMS Administrator Dr. Mehmet Oz. "CMS is restoring commonsense guardrails to Medicaid and CHIP, which will ensure that Medicaid remains a lifeline for those who are eligible and in need of quality health care."
CMS is advising states that it does not plan to approve new or extend existing section 1115 demonstration authorities that allow extended enrollment periods beyond eligibility. In some instances, children have remained enrolled for up to six years despite changes in their circumstances. Adults or specific adult subpopulations have been granted up to 24 months of continuous eligibility.
Similarly, CMS does not intend to approve new or extend existing workforce initiatives funded by Medicaid dollars, which have already involved over $1 billion in federal commitments across several states including California and New York. Current initiatives will continue until completion but are unlikely to be renewed.
This recalibrated approach aims to reinforce statutory boundaries and enhance oversight while ensuring benefits reach only those who meet eligibility requirements. The shift is expected to improve federal fund management and refocus future funding on activities aligned with the core mission of Medicaid and CHIP.
For more information on continuous eligibility and workforce initiatives, visit the provided links.
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