Federal and state Medicaid spending currently exceeds $460 billion and, with this, accountability is necessary on all levels.

To ensure Medicaid program integrity:

  • Consistent incentives must be offered for better health outcomes.
  • Services must be used appropriately.
  • The program must be monitored on an ongoing basis.
  • Programs must be managed efficiently.

In an excellent new position paper, Rethinking Medicaid Program Integrity: Eliminating Duplication and Investing in Effective, High‐value Tools, the National Association for Medicaid Directors (NAMD) defines effective program integrity, the current landscape of federal Medicaid program integrity activities, challenges that impede effective implementation, and recommendations for strengthening the nation’s approach to Medicaid program integrity.

Researchers found that the current landscape posed several challenges to reaching this objective. Specifically, researchers noted insufficient coordination across federal agencies, ineffective communication and insufficient collaboration from federal entities to states regarding program integrity activities, and the layering of untested approaches without measuring or evaluating success. The proliferation of agencies tasked with a Medicaid program integrity role at both the federal and state level could be responsible for duplication, while insufficient communication across agencies and levels could reduce prevention and recovery effort effectiveness.

  • Recommendations included:
  • Clarify state and federal government roles.
  • Improve Medicaid and Medicare collaboration.
  • Acquire resources customized to state Medicaid programs.
  • Assess the return and utility of existing program integrity initiatives.
  • Streamline and improve data access.

To read or download the full position paper, click here (PDF).