Medicaid is administered by the Department of Health and Human Services (HHS) in partnership with the states, and is the primary source of health coverage for over 50 million Americans. Enacted in 1965 as Title XIX of the Social Security Act, Medicaid provides coverage to lower-income individuals, children, and families who often do not have access to other sources of health insurance. The Medicaid program also provides long-term care services and support to seniors and individuals of all ages with disabilities.
Agency Accountable Official: Ellen Murray, Assistant Secretary for Financial Resources
All amounts are in billions of dollars
Note: HHS calculated and is reporting a rolling national improper payment rate that is based on measurements that were conducted in Fiscal Years (FYs) 2012, 2013, and 2014.
Because Medicaid payments are susceptible to improper payments, the federal government and states have a strong financial interest in ensuring that claims are paid accurately.
The Department of Health and Human Services (HHS) has developed a multi-faceted strategy to measure the national payment error rate for Medicaid, through the payment error rate measurement (PERM) program. The fee-for-service (FFS) and managed care components of these programs are measured by federal contractors, while states lead the effort in measuring errors in the eligibility component of Medicaid. The program is measured using a 17-state, 3-year rotation to produce and report national program error rates.
All improper payment rate calculations for the Medicaid program are based on the ratio of estimated dollars of improper payments to the estimated dollars of total payments. Individual state improper payment rate components are combined to calculate national component improper payment rates, and individual state Medicaid program improper payment rates across all components are combined to calculate the national Medicaid program improper payment rate.
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