GAO Finds CMS Oversight of State Medicaid Eligibility Error Corrective Actions Inadequate
The Government Accountability Office concluded that CMS inconsistently enforces required evaluations and conducts limited analysis of state corrective action plans (CAPs) addressing Medicaid eligibility errors identified through Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs. CMS accepted CAPs missing federally required elements and does not systematically analyze errors and corrective actions across states to determine effectiveness. GAO reviewed PERM reports from 2019-2025 and MEQC results from seven states, finding caseworkers were the most prevalent root cause of errors, with specific causes falling into four categories including verification failures and system processing errors. GAO recommends CMS collect all required CAP elements and conduct cross-state analyses to better support states in reducing eligibility errors and improper payments.
State Medicaid agencies face potential federal compliance findings if CMS strengthens CAP requirements, while tighter oversight could drive standardization of corrective actions proven effective across multiple states.
Finance · Managed Care
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