Department of Health and Human Services

Office of Inspector General -- AUDIT

Complete Text of Report is available in PDF format (471 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

For August 2003, we estimate that States’ Medicaid agencies paid approximately $2 million on behalf of beneficiaries who should not have been eligible because of their Medicaid eligibility in another State.  The payments were made on behalf of these beneficiaries because the States’ agencies did not share all available Medicaid eligibility information.  Medicaid eligibility in each State is based on residency.  If a resident of one State subsequently establishes residency in another State, the beneficiary’s Medicaid eligibility in the previous State should end.  The States’ agencies must redetermine the eligibility of Medicaid beneficiaries, with respect to circumstances that may change, at least every 12 months.

Based on the results of this audit, we plan to select specific State pairs for detailed audits of payments for services provided to Medicaid-eligible beneficiaries.

We recommended that the Centers for Medicare and Medicaid Services (CMS) share the results of our audit with all States to (1) emphasize the need to ensure that beneficiary eligibility changes are identified and appropriate action is taken and (2) encourage States to identify opportunities to use existing eligibility data to minimize concurrent Medicaid eligibility periods.  CMS concurred with the recommendations.