H.R. 1 Medicaid Provisions Expected to Increase State Payment Error Rates

H.R. 1 introduces Medicaid work requirements and other eligibility changes that are expected to complicate state eligibility determinations and increase payment error rates. The legislation adds new verification requirements and eligibility criteria that states must administer, creating additional documentation burdens and potential error points in the Payment Error Rate Measurement (PERM) process. These changes take effect upon enactment, with states required to implement new systems and processes to manage the added complexity. States face heightened risk of federal scrutiny and potential financial penalties as error rates climb due to the more complex eligibility landscape.

Finance · Managed Care