Pennsylvania’s fee error charge for Medicaid has considerably improved since 2019, now stands at 2.49 p.c in comparison with 8.85 p.c nationally. 

Harrisburg, PA – Department of Human Services (DHS) Secretary Dr. Val Arkoosh at this time introduced Pennsylvania’s Medicaid (also called Medical Assistance) and Children’s Health Insurance Program (CHIP) fee error charges are properly beneath the nationwide common and among the many lowest within the nation, additional demonstrating the Shapiro Administration’s dedication to fiscal duty and making certain well being protection will proceed to be there for Pennsylvanians. 

“All Pennsylvanians deserve access to high-quality, affordable health care, especially those who receive Medicaid and CHIP, including older adults, people with disabilities, children, and families with low incomes,” mentioned Secretary Arkoosh. “I am proud of DHS’ dedication to lowering the error rate, and our staff who make sure that Medicaid and CHIP are operating with financial integrity so that we can continue to serve those who rely on these programs for their health and well-being.”  

Payment Error Rate Measurement (PERM) evaluations are carried out each three years and measure improper funds for Medicaid and CHIP. For Pennsylvania’s most just lately accomplished assessment cycle in 2022, the Medicaid improper fee charge was 2.49 p.c and the CHIP improper fee charge was 5.58 p.c. Those numbers are considerably decrease than the newly reported federal figures for 2023 which present the nationwide Medicaid improper fee charge is 8.85 p.c, and the nationwide CHIP improper fee charge is 12.81 p.c. 

These numbers additionally confirmed vital enchancment over the 2019 assessment cycle, when Pennsylvania Medicaid error charge was 14.24 p.c and the CHIP error charge was 20.67 p.c. The nationwide charges for Medicaid and CHIP had been 14.90 p.c and 15.83 p.c, respectively.  

Federal companies are required to assessment applications they administer and determine these which may be vulnerable to vital improper funds, estimate any improper funds, submit these estimates to Congress, and submit a report on actions the company is taking to cut back the improper funds. Medicaid and CHIP are applications in danger for vital improper funds due to the massive quantity of companies and expenditures concerned.    

The Centers for Medicare and Medicaid Services (CMS) developed the PERM program to adjust to oversight and reporting necessities. PERM doesn’t measure fraud; it’s a measurement of funds made that didn’t meet authorized, regulatory, or administrative necessities and could also be overpayments or underpayments.  

To be taught extra about Medicaid, CHIP and the best way to apply for well being protection, go to dhs.pa.gov.  

To apply for advantages like Medicaid, CHIP, and extra, go to Pennsylvania’s profit administration web site, COMPASS.  

For extra data on medical insurance choices obtainable to Pennsylvanians, go to www.pa.gov/healthcare.  

MEDIA CONTACT: Brandon Cwalina – ra-pwdhspressoffice@pa.gov

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