The Centers for Medicare & Medicaid Services (CMS) reimburses states for most Medicaid costs and is supposed to oversee how states use funds, but its IT systems have had problems with ensuring proper oversight, and CMS no longer supports efforts to reduce duplication by state systems, the Government Accountability Office (GAO) said.

During its review, GAO estimated that 100 percent of Eligibility and Enrollment (E&E) system requests and 68 percent of Medicaid Management Information Systems (MMIS) requests lacked pertinent information essential for indicating that a complete review had been performed. Additionally, CMS “lacked a risk-based process for overseeing systems after Federal funds were provided.”

“To improve oversight, CMS has begun a new outcome-based initiative that focuses the agency’s review of state funding requests on the successful achievement of business outcomes,” GAO wrote in its report. “However, as of February 2020, CMS had not yet established a timeline for including MMIS and E&E systems in the new outcome-based process.”

To improve CMS’ processes for overseeing Federal funds for both MMIS and E&E systems, GAO made nine recommendations. Those include:

  • Developing formal, documented procedures for the advanced planning document review process and instructions on how CMS will conduct document reviews;
  • Developing a documented, comprehensive, and risk-based process for selecting IT projects for technical assistance and provide recommendations to assist states that is aimed at improving system performance;
  • Encouraging state Medicaid program officials to involve state CIOs in the oversight of Medicaid IT projects;
  • Establishing a timeline to implement outcome-based certification process for MMIS and E&E systems; and
  • Identifying similar projects that other states are pursuing to identify opportunities for sharing, leveraging, or reusing systems or where system modules are considered.
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Jordan Smith
Jordan Smith
Jordan Smith is MeriTalk SLG's Staff Reporter covering the intersection of government and technology.