Eligibility determinations (1 - 2 of 2 items) in Past 6 Months
Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments
GAO-17-386T: Published: Jan 31, 2017. Publicly Released: Jan 31, 2017.
GAO's prior work has identified four Medicaid program integrity issues—where the program is vulnerable to improper payments such as those made for services that were not covered, were not medically necessary, or were not provided—as well as actions taken by the Centers for Medicare & Medicaid Services (CMS) to address the issues and additional actions that should be taken.Enrollment Verificati...
Patient Protection and Affordable Care Act: Final Results of Undercover Testing of the Federal Marketplace and Selected State Marketplaces for Coverage Year 2015
GAO-16-792: Published: Sep 9, 2016. Publicly Released: Sep 12, 2016.
Under the Patient Protection and Affordable Care Act (PPACA), health-insurance marketplaces are required to verify application information to determine eligibility for enrollment and, if applicable, determine eligibility for income-based subsidies or Medicaid. Verification steps include reviewing and validating an applicant's Social Security number, if one is provided; citizenship, status as a U.S...