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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-09-17-02002
Report Description

Historically, only certain groups of individuals who had incomes and assets below certain thresholds were eligible for Medicaid (traditional coverage groups). After the passage of the Patient Protection and Affordable Care Act (ACA), many beneficiaries remained eligible under these traditional coverage groups. We refer to these beneficiaries as "non-newly eligible beneficiaries."

Report Type
Audit
Agency Wide
Yes
Additional Details
https://oig.hhs.gov/oas/reports/region9/91702002.asp

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
266057 No $0 $0

We recommend that the State agency redetermine, if necessary, the current Medicaid eligibility of the sampled beneficiaries who did not meet or may not have met Federal and State eligibility requirements.

266060 No $0 $0

We recommend that the State agency ensure that information is maintained in case files to support that eligibility determinations were performed in accordance with Federal and State requirements.

266062 No $0 $0

We recommend that the State agency ensure that eligibility determinations are performed only for individuals who apply for Medicaid.

266059 No $0 $0

We recommend that the State agency ensure that annual redeterminations are performed as required and properly terminate Medicaid coverage for beneficiaries, if necessary.

266058 No $0 $0

We recommend that the State agency ensure that caseworkers properly verify all eligibility requirements.

Department of Health & Human Services OIG

United States