In a letter to the acting administrator of the Centers for Medicare and Medicaid Services (CMS), House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Health Subcommittee Chairman Joseph Pitts (R-PA) questioned if basic safeguards are in place for this year’s Obamacare open enrollment.
“According to the Congressional Budget Office, the estimated cost of subsidies and related spending under the ACA between fiscal years 2016 and 2025 is nearly $850 billion,” Upton and Pitts said. “Federal expenditures for the Medicaid expansion are estimated by the CMS Office of the Actuary to be $430 billion from 2014 through 2023. With the enormous costs of these programs, it is vital to ensure that American tax dollars are being spent appropriately.”
The letter expressed concern about systemic vulnerabilities in CMS’s eligibility determinations, noting that “GAO did not find any improvements in the federal exchange’s control environment for plan year 2015” and “GAO also found vulnerabilities in the state marketplace similar to the federal exchanges.”
The letter also warned that a process is not currently in place by CMS to ensure that states claim the appropriate federal matching rate for Medicaid beneficiary expenditures.
The letter follows a recent hearing reviewing both Obamacare exchanges and Medicaid eligibility determinations.
Upton and Pitts said that they were “following up on concerning findings from an October 23rd Subcommittee on Health hearing that reviewed the inaccuracy of Medicaid and exchange eligibility determinations. We are very concerned that the lack of meaningful eligibility controls in Medicaid and the exchanges established under the Affordable Care Act puts American tax dollars at risk.”
During the hearing, CMS faced questions about how its lack of oversight could put low-income consumers at risk for higher costs or challenges in accessing care.
“Careful CMS oversight is crucial to ensure that determinations of Medicaid eligibility are appropriate, and that the risk of coverage gaps and duplicate coverage is minimized for individuals transitioning between the coverage types,” the nonpartisan Government Accountability Office said in testimony before the subcommittee.