government

Illinois Medicaid anti-fraud plan receives partial federal approval

NEWS IN BRIEF — Posted March 19, 2012

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The federal Centers for Medicare & Medicaid Services has approved part of Illinois' new anti-fraud measures for its Medicaid program after concluding previously that the efforts violated eligibility requirements authorized by the national health system reform law.

In March, the state started matching Medicaid enrollees' addresses with the state's directory of driving records, among other efforts, to ensure that assistance is going only to Illinois residents. Part of the plan requires residents to show additional proof of residency and income to confirm their status, if necessary.

Federal Medicaid officials had expressed concern that these extra verifications could violate federal maintenance-of-effort requirements under the health reform law. Those provisions require states to maintain certain eligibility levels and enrollment procedures for Medicaid until the federal Dept. of Health and Human Services deems the states' new health insurance exchanges to be fully operational for 2014.

The Illinois Healthcare and Family Services Dept. had said it would move ahead with the verification measures without federal approval, setting up a possible showdown that could have endangered the federal matching funds that the state receives.

However, CMS said in a Feb. 29 letter that the state could move forward with verifying residency through program records, electronic sources and physical documents. Those measures don't violate the reform law. The letter addressed only the residency verification procedures and did not approve the state's plan for income verification.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/03/19/gvbf0319.htm.

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