CMS Releases Comprehensive Medicaid Integrity Plan for FYs 2024 - 2028

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CMS’ Comprehensive Medicaid Integrity Plan for FYs 2024 - 2028

Today, the Centers for Medicare & Medicaid Services (CMS) released the Comprehensive Medicaid Integrity Plan for Fiscal Years 2024 - 2028 (CMIP). The CMIP is published on a recurring 5-fiscal year (FY) basis and provides a comprehensive plan for ensuring the integrity of Medicaid and the Children’s Health Insurance Program (CHIP) by combatting fraud, waste, and abuse.  

The CMIP for FYs 2024 - 2028 is divided among four main themes that align with CMS’ strategic plan:

1. Protect Programs: CMS’ primary program integrity goal is to protect sustainability of Medicaid and the Children’s Health Insurance Program (CHIP) for future generations. CMS strives to be a responsible steward of public funds and ensure accountability of states, providers and plans that participate in Medicaid and CHIP. CMS uses risk-based approaches to prioritize and evaluate program integrity vulnerabilities and develop appropriate mitigations to reduce fraud and abuse while protecting Medicaid enrollees from harm.
2. Engage State Partners: Effective Medicaid program integrity efforts require CMS and states to work in close partnership. CMS engages its state partners throughout the program integrity development and implementation process while being mindful of the uniqueness of each state’s size, delivery systems, and level of risk.
3. Advance Equity: CMS works to design, implement, and operationalize policies that support health for all the people served by Medicaid and CHIP, such as by ensuring that individuals remain enrolled when they meet eligibility requirements and have access to covered benefits.
4. Drive Innovation: CMS drives innovation to tackle health system challenges and emerging program integrity risks, creating a stronger, better Medicaid program.