FY 2014-FY2017 Eligibility Review Pilots

FY2014-FY2017 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 directed 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.  On October 7, 2015, the State Health Official Letter 15-004 issued guidance to states to extend the Medicaid and CHIP Eligibility Review Pilots for one additional year in place of the PERM and MEQC eligibility review requirements for FY 2017.

The Medicaid and CHIP Eligibility Review Pilots provide states and CMS with targeted, detailed information on the accuracy of eligibility determinations using the Affordable Care Act’s rules. The eligibility review pilots also 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 general, under these Medicaid and CHIP Eligibility Review Pilots:

• All states participate annually as a means to ensure that there are no gaps in oversight during this transition period.
• States are required to conduct five streamlined pilot measurements over the four year period with results due to CMS in June 2014, December 2014, June 2015,  June 2016 and June 2017.
• States submit project descriptions and sampling approaches to CMS for expedited approval as directed in CMS guidance.