The Centers for Medicare & Medicaid Services (CMS) and the individual states and territories jointly administer Medicaid and the State Children’s Health Insurance Program (CHIP). CMS is responsible for program administration at the federal level. CMS approves state plans and state plan amendments, waivers, and demonstration programs; enforces compliance; and provides guidance to states.
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State Compliance with Electronic Asset Verification Requirements
States are required by federal law to implement asset verification programs to determine financial eligibility for individuals applying for Medicaid on the basis of age, blindness, or disability. All states were required to implement electronic asset verification systems (AVS) by 2013; however, by 2018, over a dozen states had still not complied with this requirement. […]
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Improving the Effectiveness of Medicaid Program Integrity
Medicaid program integrity (PI) activities are meant to ensure that taxpayer dollars are spent appropriately on delivering high-quality and necessary care, and preventing and detecting fraud, waste, and abuse. State Medicaid programs have primary responsibility for PI, which includes a wide range of activities, some of which are specific to PI while others are embedded […]
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Building Capacity to Administer Medicaid and CHIP
In Chapter 4 of the June 2014 report, the Commission looks at the role of state and federal administrative capacity–people, systems, and data–in managing Medicaid and CHIP most efficiently and effectively. This chapter describes the administrative requirements for state Medicaid programs, obstacles states and the federal government face in administering Medicaid, and models and strategies […]
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