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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-07-16-04228
Report Description

The Patient Protection and Affordable Care Act (ACA) gave States the option to expand Medicaid coverage to low-income adults without dependent children and established a higher Federal reimbursement rate for services provided to these newly eligible beneficiaries. If these beneficiaries' eligibility had been incorrectly determined, payments made on their behalf (1) would have been reimbursed at a higher rate than they should have been or (2) should not have been reimbursed at all. This review is part of an ongoing series of reviews of newly eligible beneficiaries.

Report Type
Audit
Location

CO
United States

Number of Recommendations
5
Additional Details
https://oig.hhs.gov/oas/reports/region7/71604228.asp

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267352 No $0 $0

Improve the CBMS to ensure that: o it verifies income and determines eligibility by using available electronic data sources on a timely basis, o it has system functionality to terminate Medicaid coverage for beneficiaries who do not provide satisfactory documentation to resolve a citizenship discrepancy after the reasonable opportunity period ends, o the coding errors affecting eligibility determinations are identified and addressed in a timely manner, and o it has the ability to verify income that is self-attested by beneficiaries on a timely basis and through multiple sources, to include one-to-one employer matches

267353 No $0 $0

Implement in the CBMS system functions to ensure o benefits of ineligible beneficiaries are terminated in a timely manner and o income verifications are requested from beneficiaries when electronic verification does not occur within 4 months of application;

267351 No $0 $0

Redetermine, as appropriate, the current Medicaid eligibility status of the sampled beneficiaries who did not meet Federal and State eligibility requirements, with specific attention to:[17] o beneficiaries who did not meet income requirements, o beneficiaries who were eligible under a mandatory Medicaid eligibility group, o beneficiaries who did not meet citizenship requirements, and o beneficiaries who were not eligible for the new adult group but for whom the State agency claimed enhanced Federal Medicaid reimbursement;

267355 No $0 $0

Improve the accuracy of manually input case actions by: o providing eligibility caseworkers with clear policies, procedures, and guidance on eligibility determinations that comply with Federal and State requirements and that address, among other things, income calculations and parent and caretaker definitions, o providing training to and monitoring of caseworkers to improve manual input accuracy, and o implementing a process to identify and review manually input eligibility data;

267356 No $0 $0

Implement a process whereby it resolves discrepancies more promptly by reducing the time between the identification of a discrepancy and the dispatch of a discrepancy letter to the beneficiary

Department of Health & Human Services OIG

United States