CMS Launches Crackdown on Medicaid Eligibility

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) launched an oversight initiative to ensure that enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) are United States citizens, U.S. nationals or have a satisfactory immigration status. 

CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases, including the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) program.

“Medicaid is a lifeline for vulnerable Americans—and I will protect it from abuse,” said U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr. “We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law.”

States are responsible for reviewing cases, verifying the citizenship or immigration status of identified individuals, requesting additional documentation if needed and taking appropriate actions when necessary, including adjusting coverage or enforcing non-citizen eligibility rules. CMS said it is sending the first set of reports to states with all states receiving a report over the course of a month.

“Every dollar misspent is a dollar taken away from an eligible, vulnerable individual in need of Medicaid and CHIP,” said CMS Administrator Mehmet Oz. “This action underscores our unwavering commitment to program integrity, safeguarding taxpayer dollars and ensuring benefits are strictly reserved for those eligible under the law.”

Individuals without what CMS deems satisfactory immigration status may only receive limited services in certain circumstances.