**GAO-04-228**                      Published: Feb 13, 2004. Publicly Released: Mar 16, 2004.                  

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## Highlights

For years, some states have taken advantage of a loophole in Medicaid law that allows them to claim billions of dollars in excessive federal matching funds by exploiting the "upper payment limit" (UPL), which is intended to be a ceiling on federal cost sharing. Congress and the Centers for Medicare & Medicaid Services (CMS) acted to curtail UPL financing schemes through law in 2000 and regulation in 2001. CMS recognized that some states had developed a long-standing reliance on UPL funds. The law and regulation authorized transition periods of up to 8 years for states to phase out excessive UPL claims. GAO was asked to examine CMS's oversight of nursing home UPL arrangements, including the status of and the basis for transition period decisions.

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## Topics

Health Care

Cost sharing (finance)state relationsHealth care programsMedicaidIntergovernmental fiscal relationsMedical expense claimsMonitoringNursing homesOverpaymentsProgram abusesQuestionable paymentsState-administered programs