According to federal documents released this month, a number of states, including Georgia, are falling short in complying with Medicaid regulations governing reporting and application processing.  In a report from HHS, its Office of the Inspector General (OIG) revealed that 14 unspecified states failed to submit complete enrollment data as part of a quarterly report mandated by the Medicaid Interstate Match (MIM).  Although participation in MIM was made mandatory in 2009, the OIG found that states still face reporting challenges that stem from resource limitations and a lack of guidance from HHS.  But states are not just having trouble submitting data to HHS; they are also accumulating significant backlogs of Medicaid applications, which have increased dramatically in number as individuals have learned of eligibility post-ACA.  In a July 9 letter to the director of Georgia’s Medicaid program, CMS acknowledged that Georgia was not processing applications within the required 45 days and indicated that it would conduct a review of the program’s processes and procedures in an attempt to mitigate the backlog.  According to some reports, Georgia has processed only 13,000 of 89,000 applications solicited through Healthcare.gov.  Six additional states (Alaska, California, Kansas, Michigan, Missouri, and Tennessee) received similar backlog letters.

HHS appears to be stepping up efforts to address these state challenges.  In addition to reviewing application processing procedures in backlog states to identify performance-improving strategies, CMS has been charged by the OIG to provide more guidance to states on how they can comply with reporting requirements under MIM.  CMS has agreed to do so, although the timetable for the provision of such guidance is unclear.  However, HHS is immediately embarking on a macroscopic effort to improve Medicaid processes and procedures.  The agency is putting $100 million toward the Medicaid Innovation Accelerator Program, an initiative intended to accelerate state-led reforms to Medicaid operations.  The funding, allocated over five years, will be used to provide federal tools and resources to states working to identify new care and payment models, improve data analytics and quality measurements, and foster rapid evaluation of programs and dissemination of best practices. 

Additional Resources

OIG Report on MIM

CMS Letter to Director of Georgia Medicaid Program