Federal Reports

States generally determined Medicaid eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State Medicaid agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into Medicaid. From our sample of 157 beneficiaries, States correctly determined eligibility for 133 beneficiaries. We found no errors in 6 of the 10 States reviewed; however, 4 States did not determine eligibility for 17 beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 731,365 beneficiaries were eligible, but 86,672 were potentially ineligible. We also estimated that Federal and State Medicaid payments on behalf of eligible beneficiaries totaled $1.5 billion, and Federal and State Medicaid payments made on behalf of potentially ineligible beneficiaries totaled $284.1 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

States generally determined Children's Health Insurance Program (CHIP) eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State CHIP agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into CHIP. From our sample of 120 beneficiaries, States correctly determined eligibility for 110 beneficiaries. We found no eligibility errors in four of the eight States reviewed; however, four States did not determine eligibility for seven beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 148,375 beneficiaries were eligible, but 6,998 were potentially ineligible. We also estimated that Federal and State CHIP payments on behalf of eligible beneficiaries totaled $196.9 million, and Federal and State CHIP payments made on behalf of potentially ineligible beneficiaries totaled $10.6 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

The OIG identified strengths within the Generation Construction (GC) Projects organization related to (1) organizational alignment, (2) collaboration within GC departments, (3) management support of employees, and (4) employee engagement. However, we also identified inherent project management risks that, coupled with relationship issues between GC personnel and customer and support organizations, could increase the risk that GC will not be able to effectively meet its mission in the future. Specifically, both GC personnel and customer and support organizations mentioned lack of recognition of how each organization affects the other, lack of knowledge of TVA Standard Programs and Processes, lack of collaboration and communication, and conflicting priorities as issues that affect their relationships.