Insights

Explanatory analysis of Medicaid eligibility, PERM, controls, and fiscal risk. Original study work uses Research; source guides use References.

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PERM Eligibility Risk: From Audit Event to Operational Discipline

Insights

Oct 6, 2026

PERM Eligibility Risk: From Audit Event to Operational Discipline

An executive framework for Medicaid leaders managing eligibility accuracy, audit defensibility, and fiscal exposure.

Ralph Choate

Finding the Improper Payment Is Only Half the Control

Insights

Sep 14, 2026

Finding the Improper Payment Is Only Half the Control

A Medicaid overpayment is not resolved until the final amount, recovery status, federal and state shares, CMS-64 adjustment, and supporting evidence reconcile.

Ralph Choate

Medical Frailty Is Becoming a Medicaid Data-Engineering Problem

Insights

Sep 14, 2026

Medical Frailty Is Becoming a Medicaid Data-Engineering Problem

Why states need governed data, explicit exception paths, and reconstructable decisions before community-engagement operations scale.

Ralph Choate

When One Medicaid Eligibility Decision Requires Two Systems

Insights

Sep 13, 2026

When One Medicaid Eligibility Decision Requires Two Systems

When Medicaid eligibility depends on multiple platforms, audit risk moves into the handoff.

Ralph Choate

One Federal Rule, Many Medicaid Eligibility Risk Models

Insights

Sep 13, 2026

One Federal Rule, Many Medicaid Eligibility Risk Models

The same federal requirement will create different audit risks depending on how each state operationalizes eligibility control.

Ralph Choate

PERM’s Center of Gravity Is Moving to Eligibility

Insights

Sep 13, 2026

PERM’s Center of Gravity Is Moving to Eligibility

The 2027 eligibility-only PERM cycle is temporary. The management lesson should not be.

Ralph Choate

Self-Attestation Is Not the Risk. Uncontrolled Self-Attestation Is.

Insights

Aug 26, 2026

Self-Attestation Is Not the Risk. Uncontrolled Self-Attestation Is.

Why Medicaid leaders should distinguish access-friendly policy from weak evidence, inconsistent controls, and downstream fiscal exposure.

Ralph Choate

Insights

Aug 25, 2026

PERM Is Not Just an Audit

Why Medicaid leaders should treat payment error risk as an operational discipline—not a periodic compliance exercise.

Ralph Choate

Insights

PERM Eligibility Risk: From Audit Event to Operational Discipline

Finding the Improper Payment Is Only Half the Control

Medical Frailty Is Becoming a Medicaid Data-Engineering Problem

When One Medicaid Eligibility Decision Requires Two Systems

One Federal Rule, Many Medicaid Eligibility Risk Models

PERM’s Center of Gravity Is Moving to Eligibility

Self-Attestation Is Not the Risk. Uncontrolled Self-Attestation Is.

PERM Is Not Just an Audit

PERM Insights & Perspectives