New York Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries

New York did not always determine Medicaid eligibility for newly eligible beneficiaries in accordance with Federal and State requirements. In our sample of 130 beneficiaries, New York correctly determined eligibility for 90 beneficiaries. However, it did not determine eligibility for 37 beneficiaries in accordance with Federal and State requirements and did not provide supporting documentation to verify beneficiaries were newly eligible for the remaining 4 potentially ineligible beneficiaries. The total exceeds 130 because 1 beneficiary was found to be ineligible for one determination period and found to be potentially ineligible for another determination period. On the basis of our sample results, we estimated that New York made Federal Medicaid payments of $26.2 million on behalf of 47,271 ineligible beneficiaries.