明尼阿波利斯所在明尼苏达州超1.12亿美元医疗补助遭联邦永久拒付 州政府有60天申诉期
联邦医疗保险和医疗补助服务中心（CMS）已永久拒绝向明尼苏达州支付超过1.12亿美元的医疗补助报销款，涉及截至2025年9月30日的季度。这一决定于2026年11月10日由明尼苏达公共电台首先报道，相关报道于11月11日刊出。被拒付的款项源于CMS今年2月发出的2.59亿美元暂缓拨款，主要涉及2025年7月至9月期间提供的高风险服务。暂缓拨款只是暂时停发联邦资金，而拒付则是永久拒绝，明尼苏达州今年3月已就被冻结资金起诉CMS和美国卫生与公众服务部。明尼苏达州人类服务部临时专员约翰·康诺利博士告诉部门负责人，州政府预计会有一定金额被拒付，但实际被拒金额约为最初被标记索赔金额的1000倍。州政府正在质疑CMS如何从该季度600多万件高风险索赔中抽取330件进行审查，以及如何得出最终拒付金额。自2月以来，CMS已暂缓明尼苏达州5.5亿美元医疗补助资金，另有两笔共计3.5亿美元、涉及随后几个季度的冻结尚未裁决。州官员表示，CMS未回应多次索取信息的要求；由于州政府已先行垫付，若拒付成立，可能需要追回资金。州政府有60天时间就此拒付提出申诉，康诺利表示，州政府将在决定下一步之前先索取更多信息。
More Than $112 Million in Minnesota Medicaid Funds Permanently Denied by Federal Government; State Has 60 Days to Appeal
The Centers for Medicare & Medicaid Services (CMS) has permanently denied Minnesota more than $112 million in Medicaid reimbursement for the quarter ending September 30, 2025. The decision was first reported by Minnesota Public Radio on November 10, 2026, with related coverage published November 11. The denied funds stem from a $259 million deferral CMS issued in February, mainly involving high-risk services provided from July through September 2025.
A deferral temporarily withholds federal funds; a disallowance is a permanent denial. Minnesota sued CMS and the US Department of Health and Human Services in March over the frozen funds. Dr. John Connolly, interim commissioner of the Minnesota Department of Human Services, told agency leaders the state had expected some amount to be disallowed, but the actual figure was about 1,000 times the amount initially flagged. The state is questioning how CMS sampled 330 claims out of more than 6 million high-risk claims that quarter and how it arrived at the final disallowance.
Since February, CMS has deferred $550 million in Minnesota Medicaid funds, with two further deferrals totaling $350 million for subsequent quarters still undecided. State officials said CMS has not responded to repeated requests for information; because the state has already paid out the money, it may need to recoup funds if the denial stands. The state has 60 days to appeal, and Connolly said it will seek more information before deciding its next steps.
来源：Becker's Hospital Review
发布：GSM·美国（发布链接）
图片来源：图：明尼苏达州议会大厦。图片来源：Wikimedia Commons，McGhiever 摄，CC BY-SA 4.0。 Image: The Minnesota State Capitol. Source: Wikimedia Commons, photo by McGhiever, CC BY-SA 4.0.
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