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Program Integrity

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  • CMS Weaponizes Fraud Against Medicaid in Minnesota

    [Editor’s Note: Read Part 2 of “CMS Weaponizes Fraud Against Medicaid in Minnesota series here.] On January 6, 2026, the Centers for Medicare & Medicaid Services (CMS) Administrator, Dr. Mehmet Oz, sent a letter to the Governor of Minnesota, Tim Walz, notifying him that his state’s Medicaid agency was “operating its program in substantial noncompliance”…

  • Tracking State Readiness to Implement HR 1

    This tracker will report on eight state-reported Medicaid and CHIP performance indicators. The analysis of state data is displayed in national maps for the most recent quarter broken into four quartiles with the top quartile reflecting the highest performing states. To smooth out monthly anomalies in state workload and allow for tracking these metrics over time,…

  • Webinar: Budget Reconciliation (HR1) Medicaid and Marketplace Provisions

    In Partnership with Monday, July 28, 2025 the Georgetown University McCourt School of Public Policy Center for Children and Families (CCF) and Center on Health Insurance Reforms (CHIR) held a joint webinar about the Medicaid and Marketplace provisions of the new budget reconciliation law (HR1). Experts at CCF and CHIR explained the provisions of the…

  • CMS Plans Major Upgrade to Faulty Account Transfer Process Between the Federal Marketplace and State Medicaid Agencies

    Last week CMS announced plans to replace the technology and processes used to coordinate eligibility and enrollment through electronic accounts between the federal marketplace (healthcare.gov) and states that use the federal platform. The account transfer (AT) process, although riddled with glitches, has been in place since the Affordable Care Act’s coverage expansions began in 2014.…

  • Trump-appointed Federal Court Judge Undercuts Important Legal Tool Used to Eliminate Health Care Fraud

    Ultra-conservative politicians often use the risk of health care fraud to stoke fears about investing in public health care programs like Medicaid and Medicare. The funny thing is, their own judges appear to be working hard to make fraud more common. On September 30, 2024, a Trump-appointed Florida judge issued a radical decision to weaken…