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FY 2014-FY2016 Eligibility Review Pilots

FY2014-FY2016 Medicaid and CHIP Eligibility Review Pilots

In light of the changes to the way states adjudicate eligibility for applicants for Medicaid and CHIP implemented by the Affordable Care Act, the State Health Official Letter 13-005 issued on August 15, 2013 directs states to implement Medicaid and CHIP Eligibility Review Pilots in place of the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) eligibility review requirements for fiscal years (FY) 2014-2016.  The Medicaid and CHIP Eligibility Review Pilots will provide more targeted, detailed information on the accuracy of eligibility determinations using the Affordable Care Act’s rules, and provide states and CMS with critical feedback during initial implementation.  
The eligibility review pilots will provide a testing ground for different approaches and methodologies for producing reliable results and help inform CMS’s approach to rulemaking that it will undertake prior to the resumption of PERM eligibility measurement component in FY 2017.

In general, under these Medicaid and CHIP Eligibility Review Pilots:

• All states will participate annually as a means to ensure that there are no gaps in oversight during this transition period.
• States will be conducting four streamlined pilot measurements over the three year period and results will be reported to CMS in June 2014, December 2014, June 2015 and June 2016.
• States will submit project descriptions and sampling approaches to CMS for expedited approval as directed in CMS guidance.

Please submit questions to the FY2014-2016EligibilityPilots@cms.hhs.gov mailbox.