Medicaid
Department of Health and Human Services
Medicaid is administered by the Department of Health and Human Services (HHS) in partnership with the states, and is the primary source of health coverage for over 50 million Americans. Enacted in 1965 as Title XIX of the Social Security Act, Medicaid provides coverage to lower-income individuals, children, and families who often do not have access to other sources of health insurance. The Medicaid program also provides long-term care services and support to seniors and individuals of all ages with disabilities.
Agency Accountable Official: Ellen Murray, Assistant Secretary for Financial Resources
Program Accountable Official: Peter Budetti, Deputy Administrator for Program Integrity, Centers for Medicare and Medicaid Services
Note: The baseline measurement for Medicaid, based on the measurement of 50 states and the District of Columbia (DC) over a three year period, is published in the FY 2010 Agency Financial Report (AFR). This is the first year that HHS calculated and is reporting a three-year weighted national error rate that includes data from FYs 2008, 2009 and 2010. Therefore, it is also the first year that OMB and HHS has set reduction targets for the program that are published in the FY 2010 AFR.
Program Comments
Because Medicaid payments are susceptible to improper payments, the federal government and states have a strong financial interest in ensuring that claims are paid accurately.
The Department of Health and Human Services (HHS) has developed a multi-faceted strategy to measure the national payment error rate for Medicaid, through a payment error rate measurement program. The fee-for-service and managed care components of these programs are measured by federal contractors, while states lead the effort in measuring errors in the eligibility component of Medicaid. The program is measured using a 17-state, 3-year rotation to produce and report national program error rates. The program is relatively new and HHS is in the process of finalizing policies related to the measurement of improper payments in Medicaid. Read More...