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Direct dollars to beneficiaries more effectively and responsibly. The

current funding structure for the Medicaid program rewards expansions,

lacks transparency, and promotes financing gimmicks. CMS should:

End state financing loopholes. Reform payments to hospitals for uncompensated care.

Replace the enhanced match rate with a fairer and more rational match rate.

Restructure basic financing and put the program on a more fiscally predictable budget (which should include reform of Disproportionate Share Hospital payments to hospitals).*!

Strengthen program integrity. Make program integrity a top priority and the responsibility of the states. To protect the taxpayers’ investment:

Incentivize states. An enhanced contingency fee should be paid to states that successfully increase their efforts to decrease waste, fraud, and abuse. The current system’s IT development 90/10 matching rate should be allowed for improvements in states’ current fraud and abuse and eligibility systems. Innovative programs that show a positive return on investment for both the state and federal governments should be allowed without the onerous waiver process.

Improve Medicaid eligibility standards to protect those in need. As Medicaid enrollment continues to climb, it is imperative that there are appropriate and accurate eligibility standards to ensure that the program remains focused on serving those who are in need. To this end, CMS should:

a. Hold states accountable for improper eligibility determinations. b. Require more robust eligibility determinations.

c. Strengthen asset test determinations within Medicaid.”

Conduct oversight and reform of managed care.”

Incentivize personal responsibility. CMS should allow states to ensure

that Medicaid recipients have a stake in their personal health care anda

say in decisions related to the Medicaid program. Personal responsibility