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Forthcoming Rule on Program Integrity and Eligibility Determination Processes

A proposed rule, which “would strengthen the integrity of the Medicaid eligibility determination process including verification, changes in circumstance, and redetermination”, is slated for release in April 2020. In anticipation, this presentation provides a review of the existing rules and the experiences in states related to administrative simplification and accuracy of determinations. It concludes with aspects of the rule for which changes might be proposed and areas for potential Commission comment.