Finding: 2025-055 - Sixty Medicaid and sixty Children’s Health Insurance Program (CHIP) recipients were randomly selected for eligibility testing. Testing revealed the following errors: Medicaid 14 of 60 cases had timing issues (note, some cases had multiple deficiencies): • Seven of the sixty cases...
Finding: 2025-055 - Sixty Medicaid and sixty Children’s Health Insurance Program (CHIP) recipients were randomly selected for eligibility testing. Testing revealed the following errors: Medicaid 14 of 60 cases had timing issues (note, some cases had multiple deficiencies): • Seven of the sixty cases had not gone through a renewal assessment within 12 months of the last determination. • Eleven of the sixty cases’ eligibility determinations were not done timely (i.e., within 45 days). CHIP 26 of 60 cases had timing issues (note, some cases had multiple deficiencies): • Fifteen of sixty cases’ eligibility determinations were not done timely (i.e., within 45 days). • Eighteen of sixty cases had not gone through a renewal assessment within 12 months of the last determination. Questioned Costs: AL 93.778: 2,653 (known questioned costs); 712,969,620 (likely questioned costs), AL 93.767: 2,825 (known questioned costs); 5,719,575 (likely questioned costs) Assistance Listing Number: 93.767, 93.775, 93.777, 93.778 Assistance Listing Title: CHIP Medicaid Cluster Views of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): The department agrees with the finding but does not concur with the questioned costs. CMS has notified the state that financial recoveries based on eligibility errors can only be pursued when identified by programs operating under CMS’ Payment Error Rate Measurement (PERM) program, under section 1903(u) of the Social Security Act and regulations at 42 CFR Part 431, Subpart Q. Corrective Action (corrective action planned): The Division of Public Assistance continues engaging with contractors to incorporate system upgrades to improve timeliness and accuracy with Medicaid determinations. The division will provide additional eligibility resources to ensure timely review of Medicaid cases. Completion Date (list anticipated completion date): The department anticipates the finding will be resolved in FY2027. Agency Contact (name of person responsible for corrective action): Pam Halloran, Assistant Commissioner