CMS Issues Interim Final Rule to Enforce Medicaid Redetermination Requirements

This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.

The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to submit a corrective action plan, and if the state fails to submit or implement the plan, the agency may fine up to $100,000 per day that it is not in compliance, Becker’s reports. It may also reduce the amount of federal funding given to state Medicaid programs up to one percentage point for noncompliance with reporting requirements.

The Biden administration has come under fire in recent months over the high volume of Medicaid enrollment losses, and the rule gives CMS authority to enforce rules that would protect qualified beneficiaries from coverage loss. According to Modern Healthcare, seven out of 10 disenrollments as of December 1 were for procedural reasons, meaning that the state was unable to contact or verify paperwork, rather than the member failing to qualify for the program. The agency ordered 30 states to halt disenrollements and restore coverage to people inappropriately cut from the program in September.

The comment period on the interim final rule ended on Wednesday, December 6. The interim final rule may be read in full at Regulations.gov