Find resources to help you understand the ins and outs of CMS’ program integrity efforts, and read the annual reports that we submit to Congress about our center and our programs.

Reports to Congress

Medicaid Program Integrity Reports

Comprehensive Medicaid Integrity Plan, FY 2024 - FY 2028 (PDF)
This CMIP sets forth CMS’ strategy for working with states to safeguard the integrity of Medicaid and the Children’s Health Insurance Program (CHIP) during fiscal years (FYs) 2024 –2028. CMS will work closely with state partners to implement the strategies outlined in the CMIP. Mindful of the uniqueness of each state Medicaid program, this CMIP empowers individual states to create innovative programs that best address program integrity challenges while providing CMS with the tools to effectively promote Medicaid program integrity and safeguard taxpayer dollars over the next 5 years.

Beneficiary Eligibility Audits
As part of the Comprehensive Medicaid Integrity Plan for FYs 2019-2023 and the Medicaid Program Integrity Strategy, CMS is conducting beneficiary eligibility audits. The primary goal of these audits is to confirm that states’ Medicaid and Children’s Health Insurance Program (CHIP) beneficiary eligibility determinations are appropriate and that the federal match is correctly assessed.

Completed Medicaid and CHIP beneficiary eligibility audit reports are included below:

• New York Medicaid Beneficiary Eligibility Determinations (PDF)
• Kentucky Medicaid Beneficiary Eligibility Determinations (PDF)
• Louisiana Medicaid Beneficiary Eligibility Determinations (PDF)
• Pennsylvania Medicaid and CHIP Beneficiary Eligibility Determinations (PDF)
• Connecticut Medicaid and CHIP Beneficiary Eligibility Determinations (PDF)
• Kansas Medicaid and CHIP Beneficiary Eligibility Determinations (PDF)
• Missouri Medicaid and CHIP Beneficiary Eligibility Determinations (PDF)

Medical Loss Ratio (MLR) Audits
A key component of CMS' managed care program integrity work is to conduct targeted audits of selected states' Medicaid Managed Care Plans' (MCPs) financial reporting.  As part of this effort, CMS conducts audits of states' Medicaid MCPs MLR reporting to determine if MCPs submitted annual MLR reports to the state in accordance with federal requirements, and that annual MLR reporting and remittance calculations for the MCPs were supported by the underlying data and supporting documentation received by the state.

Completed MLR audit reports are included below:

• California Medical Loss Ratio Examination Report (PDF)
• Oregon Medicaid Managed Care Medical Loss Ratio Audit Report (PDF)

State Program Integrity Review Reports, 2007 – 2019
This page describes the state program integrity (PI) review reports, and respective follow-up review reports, that provide CMS' assessment of the effectiveness of States' Medicaid PI efforts, including compliance with Federal statutory & regulatory requirements.

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