CMS audits Texas over Medicaid redeterminations

CMS is auditing Texas HHS to ensure the state is complying with federal requirements amid the Medicaid redeterminations process, the Austin American-Statesman reported Sept. 20.

According to the report, CMS did not say if additional states are being audited. The agency is examining individuals who were denied Medicaid coverage during August.

In August, anonymous employees with Texas HHS filed a whistleblower complaint against the agency over "numerous and growing system issues" they say are leading to incorrectly terminated health coverage during redeterminations.

"The persistence of numerous and growing system issues remains evident, causing erroneous denials of coverage, particularly impacting newborns and pregnant women—creating a situation that could further agitate our noncompliance with CMS guidelines," the employees wrote to Texas HHS Commissioner Cecile Young in the complaint obtained by Nexstar.

In response to the complaint, Texas HHS said about 95,000 people have been incorrectly removed from the Medicaid program during redeterminations, but the vast majority saw their coverage reinstated before the end of August.

"We are working closely with Centers for Medicare & Medicaid Services and our partners to ensure that the redetermination process operates as smoothly as possible," a spokesperson for the agency told Nexstar. "We are aware of some Medicaid cases that were denied improperly, and we've reinstated coverage for those individuals."

In August, CMS sent letters to Medicaid directors in all 50 states, evaluating states' performance on Medicaid call center wait times and call abandonment rates, rates of procedural terminations, and the average wait time for applications to be approved. The agency warned 36 states they were falling short of regulatory requirements in at least one area.

As of Sept. 20, more than 7 million people have been disenrolled from Medicaid, according to KFF. Among those, 73 percent have been for procedural reasons.

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