On November 18, 2019, the U.S. Department of Health and Human Services released the annual Agency Financial Report (AFR), which includes Medicaid and State Children’s Health Insurance Program (CHIP) improper payment rate estimates for fiscal year (FY) 2019.
The FY 2019 AFR is significant because it contains the first Medicaid and CHIP estimates that incorporate errors based on eligibility since the implementation of major Medicaid changes required by the Patient Protection and Affordable Care Act in 2014. Many state and federal policymakers were waiting for this estimate, as there had been little information on the accuracy of eligibility determinations since the eligibility component of the Payment Error Rate Measurement (PERM) was replaced with a pilot approach for the FY 2014–2017 measurement cycles.
This presentation provides a review of the PERM program, a discussion of the recent findings, and the implications of these findings for both eligibility and provider screening and enrollment.