PENNSYLVANIA — The Department of Human Services (DHS) in Pennsylvania has reported a notable decrease in payment error rates for the state’s Medicaid and Children’s Health Insurance Program (CHIP). The current rates are not only well below the national average but also rank among the lowest in the country. This development underscores the Shapiro Administration’s commitment to fiscal responsibility and ensuring continued health coverage for Pennsylvanians.
Dr. Val Arkoosh, Secretary of the DHS, lauded the department’s efforts in reducing the error rate. “Our staff ensures that Medicaid and CHIP operate with financial integrity so we can continue to serve those who rely on these programs, including older adults, people with disabilities, children, and families with low incomes,” stated Secretary Arkoosh.
Payment Error Rate Measurement (PERM) reviews, conducted triennially, measure improper payments for Medicaid and CHIP. In Pennsylvania’s most recent review cycle in 2022, the Medicaid improper payment rate was 2.49 percent, and the CHIP improper payment rate was 5.58 percent. These figures are significantly lower than the federal figures for 2023, which report a national Medicaid improper payment rate of 8.85 percent and a national CHIP improper payment rate of 12.81 percent.
The current rates reflect a substantial improvement from the 2019 review cycle when Pennsylvania’s Medicaid error rate was 14.24 percent, and the CHIP error rate was 20.67 percent. During the same period, the national rates for Medicaid and CHIP were 14.90 percent and 15.83 percent, respectively.
Federal agencies are mandated to review programs they administer, identify those susceptible to significant improper payments, estimate any improper payments, submit those estimates to Congress, and report on actions taken to reduce the improper payments. Medicaid and CHIP are programs at risk for significant improper payments due to the large volume of services and expenditures involved.
The Centers for Medicare and Medicaid Services (CMS) developed the PERM program to comply with oversight and reporting requirements. It’s important to note that PERM does not measure fraud but rather payments made that did not meet legal, regulatory, or administrative requirements.
Pennsylvania residents can learn more about Medicaid, CHIP, and how to apply for health coverage on the DHS website. Applications for benefits like Medicaid, CHIP, and more can be made through Pennsylvania’s benefit management website, COMPASS. More information on health insurance options available to Pennsylvanians is available at www.pa.gov/healthcare.
For the latest news on everything happening in Chester County and the surrounding area, be sure to follow MyChesCo on Google News and Microsoft Start.