Finding: 2023-051 - Sixty Medicaid and sixty CHIP recipients were randomly selected for eligibility testing. Auditors found inaccurate or unsupported eligibility determinations by State staff for 5 percent of Medicaid cases tested and 6 percent of CHIP cases tested. Testing revealed the following er...
Finding: 2023-051 - Sixty Medicaid and sixty CHIP recipients were randomly selected for eligibility testing. Auditors found inaccurate or unsupported eligibility determinations by State staff for 5 percent of Medicaid cases tested and 6 percent of CHIP cases tested. Testing revealed the following errors:
Medicaid:
• One case was ineligible for the whole year and benefits were available the whole year.
• Two cases lacked documentation supporting the request and use of income and benefit information through the Income Eligibility and Verification System for determining eligibility and benefits.
CHIP:
• One case’s application hasn’t been processed as of 6/30/2023 but benefits were paid during the year ended June 30, 2023.
• One case was a child that had turned 19 in a previous year but benefits continued to be paid during the year ended June 30, 2023.
• Two cases had unresolved help desk tickets about how to close a case, which led to the cases remaining open and benefits to be paid for one of the cases during the year ended June 30, 2023.
Questioned Costs: AL 93.767: $ 167; AL 93.778: $ 960
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): DOH agrees with the finding but not 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 will continue to strengthen online staff development and training offerings available in the department’s electronic training portal, including courses on MAGI/CHIP Medicaid and ARIES. The agency continues to streamline the Statewide Case Review Team and the case review guidelines with the goal of increasing timeliness and accuracy. The division continues to work through public health emergency (PHE) priorities and mandates, PHE unwinding, and continues to experience staffing shortages. This will likely impact the ability to immediately execute the corrective action plan.
Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2025.
Agency Contact (name of person responsible for corrective action): Josie Stern, Assistant Commissioner