The Centers for Medicare & Medicaid Services is launching a focused review of how the states of Missouri and Texas process Medicaid applications.
Delays in processing could result in funding cuts, Modern Healthcare reported. CMS declined to tell the media outlet whether it sent similar letters to other states.
According to a letter sent to Texas’ state Medicaid director on May 22, CMS is planning to conduct a “focused review” of the state’s procedures for processing applications, “particularly given the prolonged period of the state’s noncompliance.”
A similar letter was sent to Missouri, according to the Columbia Missourian.
The letters follow an interim final rule that CMS published in December meant to ensure that states are following reporting guidelines and maintaining compliance with disenrollment procedures.
CMS’ enforcement authorities under the rule include the ability to require states to submit a corrective action plan for any noncompliance, suspend a state’s procedural Medicaid disenrollments, impose civil money penalties or even reduce a state’s federal medical assistance percentage, also known as FMAP.
“We see this rule as an attempt by CMS to hold states accountable for failure to maintain access to services and health care coverage for individuals that would otherwise remain eligible,” Georgia Goodman, Medicaid director at LeadingAge said in a statement to McKnight’s Home Care in December. “By creating a punitive enforcement framework, CMS has levers to compel states to change their processes to better protect Medicaid enrollees from termination.”
“As of February, Missouri’s 72% noncompliance rate stands far above other states. The next highest were New Mexico (58%), Alaska (53%) and Texas (46%),” the Columbia Missourian reported.
Federal law requires that states review Medicaid applications within 45 days. Most states process Medicaid applications within 24 hours, the media outlet reported, but in December 2023, it took the state of Missouri longer than 45 days to process about half of its applications.
