Letter to Hon. Chiquita Brooks-Lasure, Administrator, Centers for Medicare and Medicaid Services - Crapo Leads Finance Committee Republicans in Raising Concerns With Improper Medicaid Payments

Letter

Dear Administrator Brooks-LaSure:
As some in Congress consider proposals to expand the Medicaid program by potentially half a
trillion dollars over the next decade, it is vital that both Senators and Members of the House of
Representatives have accurate information about how the program is using taxpayer resources.
Every November, the Centers for Medicare and Medicaid Services (CMS) releases estimates of
improper payment rates for programs within its jurisdiction. The November 2020 report showed
that the Medicaid improper payment rate reached 21.4 percent, with total federal improper
payments in the program amounting to $86.5 billion annually.1 Medicaid's improper payment
rate has significantly increased since the passage of the Affordable Care Act, which dramatically
expanded Medicaid. In 2013, the year before the ACA's Medicaid expansion took effect, the
improper payment rate was just 5.8 percent.2
According to last year's report, eligibility errors are the major drivers of the increased Medicaid
improper payment rate. According to CMS, "Eligibility errors are mostly due to insufficient
documentation to affirmatively verify eligibility determinations or non-compliance with
eligibility redetermination requirements."3 One of the most common eligibility errors often
occurs when failing to verify information provided by the applicant, including income. Failure to
properly verify that applicants are eligible for the program, especially to this extent, harms the
nation's taxpayers and takes resources away from those who are eligible and who truly need the
program.
There is concern that the November 2020 improper payment rate estimate of 21.4 percent was
unrealistically low because the eligibility reviews excluded one-third of states.4 Since the Obama
Administration cancelled eligibility audits from 2014-2017, this year's forthcoming report will
be the first complete assessment of all states since the expansion took effect. Given its more complete nature, the upcoming assessment has the potential to show that the improper payment
rate in the program exceeds 25 percent, totaling above $100 billion annually.
Such a high improper payment rate demonstrates that the program requires a stalwart defense to
ensure those that are eligible receive the care they need. This rate also raises questions of
whether Congressional and regulatory actions have made Medicaid too complicated for the
Federal government to properly oversee it, especially given the differing improper payment rates
among states. Congress needs complete and updated information about the improper payment
rate in Medicaid as well as the corresponding drivers of this problem. We understand that the
essential work on the 2021 CMS improper payment report has concluded, and drafts of the report
have been completed. While state and Federal responses to COVID-19 halted some payment and
eligibility reviews in 2020, this work is too vital to remain paused when the consequences are so
dire.
Given the importance of accurate data to inform ongoing policy discussions, by Monday,
November 8, we ask that you provide:
 The updated improper payment rate in Medicaid;
 A breakdown of improper payment rates by state; and
 The corresponding estimated total of improper payments from insufficient verification or
non-compliance with eligibility requirements.
When asked about this at a June hearing in front of the Senate Finance Committee, Secretary
Becerra committed to making available such data5
. We also request a briefing with Committee
Members' staff, so that Congress can ask informed questions on this important matter. Thank
you for your prompt attention to this shared concern.
Sincerely,
______________________________ _______________________