On Tuesday, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced that the agencies deferred over $1 billion in Medicaid payments for certain high-risk Medicaid claims in two states, including home-based services.  

HHS and CMS have deferred $867.5 million in federal Medicaid payments to California and $199 million to Minnesota, according to the Tuesday announcement.  

“In Minnesota, we’re talking about 14 high-risk programs, high-risk service categories like personal care and home-based services,” CMS Administrator Dr. Mehmet Oz said in a press conference. “Again, often these are services that your family would typically have provided for you that the federal government has started to fund, but unfortunately, it can be abused.”

In California, deferrals include payments for certain in-home care programs after the agencies identified “spending growth that far exceeded national trends and other claims that require additional documentation.”

The deferrals are not permanent payment cuts, according to HHS, and both states will have the opportunity to provide documentation showing the claims meet federal Medicaid requirements.

HHS also announced that the agency will expand its exclusion authority, enabling CMS and the HHS Office of Inspector General to remove bad actors from federal healthcare programs. In many cases, this would permanently bar bad actors, according to CMS’ announcement.  

This story is developing. Check back for more information as it is available.

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