Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State

Previous Office of Inspector General (OIG) audits found that State Medicaid agencies had improperly paid capitation payments on behalf of beneficiaries with concurrent eligibility in another State. We conducted a similar audit of Minnesota’s Medicaid program.Our audit covered 7,706 August 2018 capitation payments, totaling $4.0 million, made on behalf of beneficiaries with concurrent eligibility in another State during our audit period, July 1 through September 30, 2018. We selected the middle month of our audit period to ensure that beneficiaries were eligible in the months before and after the August 2018 capitation payments. We selected a stratified random sample of 106 capitation payments, totaling $45,919 ($29,458 Federal share), and determined whether the beneficiaries were residing and receiving Medicaid benefits in Minnesota during the audit period.