• ipharmaservices

New guidance issued by CMC to safeguard and maintain the integrity of Medicaid enrollees

Updated: Oct 3, 2019

CMC issued a new guidance to preserve the integrity of Medicaid enrollees. The new guidance ensures more programmatic and financial integrity of the Medicaid program.


CMC has issued guidance to ensure that the resources are reserved for those patients who are eligible for the treatment. This guidance was follow up of the Medicaid Program Integrity strategy released last year. The strategy was released to enhance programmatic and financial integrity. As per the guidance, new audits will be performed to determine state eligibility and manage care financial reporting, guidance also enhances state reporting.


CMC will audit Medicaid managed care plans, financial reporting, and Medical Loss Ratios. The recent audits conducted by Officer of Inspector General (OIG), which found some states expanded the Medicaid to patients who haven’t met the eligibility criteria as per the federal and state requirements.


Since 2014, 15 million new working-age group adults were enrolled in the Medicaid program.



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