Shapiro Administration Announces Significant Improvement In Medicaid, CHIP Payment Error Rates, Pennsylvania Rates Well Below National Average
Department of Human Services (DHS) Secretary Dr. Val Arkoosh today announced Pennsylvania’s Medicaid (also known as Medical Assistance) and Children’s Health Insurance Program (CHIP) payment error rates are well below the national average and among the lowest in the country, further demonstrating the Shapiro Administration’s commitment to fiscal responsibility and ensuring health coverage will continue to be there for Pennsylvanians.
“All Pennsylvanians deserve access to high-quality, affordable health care, especially those who receive Medicaid and CHIP, including older adults, people with disabilities, children, and families with low incomes,” said Secretary Arkoosh. “I am proud of DHS’ dedication to lowering the error rate, and our staff who make sure that Medicaid and CHIP are operating with financial integrity so that we can continue to serve those who rely on these programs for their health and well-being.”
Payment Error Rate Measurement (PERM) reviews are conducted every three years and measure improper payments for Medicaid and CHIP. For Pennsylvania’s most recently completed review cycle in 2022, the Medicaid improper payment rate was 2.49 percent and the CHIP improper payment rate was 5.58 percent. Those numbers are significantly lower than the newly reported federal figures for 2023 which show the national Medicaid improper payment rate is 8.85 percent, and the national CHIP improper payment rate is 12.81 percent.
These numbers also showed significant improvement over the 2019 review cycle, when Pennsylvania Medicaid error rate was 14.24 percent and the CHIP error rate was 20.67 percent. The national rates for Medicaid and CHIP were 14.90 percent and 15.83 percent, respectively.
Federal agencies are required to review programs they administer and identify those that may be susceptible to significant improper payments, estimate any improper payments, submit those estimates to Congress, and submit a report on actions the agency is taking to reduce the improper payments. Medicaid and CHIP are programs at risk for significant improper payments because of the large volume of services and expenditures involved.
The Centers for Medicare and Medicaid Services (CMS) developed the PERM program to comply with oversight and reporting requirements. PERM does not measure fraud; it is a measurement of payments made that did not meet legal, regulatory, or administrative requirements and may be overpayments or underpayments.
To learn more about Medicaid, CHIP and how to apply for health coverage, visit dhs.pa.gov.
To apply for benefits like Medicaid, CHIP, and more, visit Pennsylvania’s benefit management website, COMPASS.
For more information on health insurance options available to Pennsylvanians, visit www.pa.gov/healthcare.