The Centers for Medicare & Medicaid Services (CMS) has introduced a new oversight initiative designed to verify the eligibility of enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) based on federal citizenship and immigration status requirements. This initiative aims to enhance program integrity, ensuring that taxpayer-funded benefits are allocated only to individuals legally eligible for these services.
Under the new program, CMS will deliver monthly enrollment reports to states, highlighting individuals whose citizenship or immigration status remains unverified through federal databases. These databases include the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program. States are required to review flagged cases, request further documentation when needed, and take appropriate action, which may involve adjusting coverage or enforcing eligibility rules for non-citizens.
Robert F. Kennedy, Jr., U.S. Secretary of Health and Human Services, stated, “Medicaid is a lifeline for vulnerable Americans — and I will protect it from abuse.” He emphasized the importance of tightening oversight to safeguard taxpayer dollars and ensure that Medicaid and CHIP serve only those who meet legal eligibility criteria.
State Responsibilities and Oversight
The first round of reports is being sent to states starting today, with all states expected to receive their initial reports within the next month. The responsibility for promptly reviewing these identified cases rests with the states, which must take corrective action where necessary. Dr. Mehmet Oz, CMS Administrator, highlighted the agency’s commitment to safeguarding resources, stating, “Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP.”
Under existing federal law, individuals without satisfactory immigration status are generally ineligible for full Medicaid or CHIP benefits. However, they may qualify for limited emergency medical services under certain conditions. The new initiative reinforces the need for states to adhere to federal eligibility requirements while ensuring that resources are preserved for those who qualify.
Commitment to Program Integrity
CMS has committed to closely monitoring state compliance on a monthly basis, ensuring that necessary corrective actions are implemented. This initiative reflects the agency’s broader goals of promoting transparency, enforcing eligibility standards, and maintaining the long-term stability of Medicaid and CHIP. By enhancing oversight and supporting enforcement at the state level, CMS aims to uphold the integrity of these essential programs.
The initiative underscores the importance of ensuring that assistance remains available for eligible low-income families, children, and individuals who rely on Medicaid and CHIP for vital healthcare services. This proactive approach is part of CMS’s ongoing efforts to ensure that taxpayer dollars are used effectively and responsibly.