Waste, fraud, and abuse within Medicaid costs taxpayers billions of dollars and steals limited resources from the truly needy. In fact, federal auditors estimate that more than 10 percent of all Medicaid spending is improper. Eligibility determination errors account for most improper payments made by the Medicaid programs.
While the Medicaid program has struggled with program integrity issues for years, two Obama-era regulations made this problem even worse by limiting how frequently states can check eligibility for individuals on Medicaid and what type of information states can request to verify eligibility. These regulations overturned longstanding policy at the Centers for Medicare and Medicaid Services (CMS), removed state flexibility, and created new gaps in program integrity. As policymakers consider steps to crack down on Medicaid fraud, reversing these two regulatory changes should be at the top of their list.