OIG: California's Medicaid expansion signed up 366k ineligible people

California enrolled hundreds of thousands ineligible or "potentially" ineligible beneficiaries under Medicaid expansion, according to estimates detailed in a report from HHS' Office of Inspector General.

For the Feb. 21 report, the OIG examined a sample of 150 newly eligible expansion beneficiaries who received Medicaid services from October 2014 through March 2015. It found California spent money on 112 eligible expansion beneficiaries and 38 ineligible or potentially ineligible expansion beneficiaries. The report cited "a woman who did not meet eligibility requirements for the newly eligible group because she was pregnant" as an example of an ineligible beneficiary and an individual "who may not have met the residency requirement" as an example of a potentially ineligible beneficiary.

The OIG used the 150 beneficiary sample to generate estimates on the state's overall Medicaid spend. The estimates suggest California spent $738.2 million on 366,078 ineligible expansion beneficiaries and $416.5 million on 79,055 potentially ineligible expansion beneficiaries. Of the $1.15 billion in payments, roughly $1 billion included federal money. The remaining funds came from the state's Medicaid program, according to auditors.

"These deficiencies occurred because California's eligibility determination systems lacked the necessary system functionality and eligibility caseworkers made errors," the OIG wrote. "We also identified a weakness in California's procedures related to determining eligibility of individuals who may not have intended to apply for Medicaid."

Based on its findings, the OIG made multiple recommendations. These included "redetermin[ing], if necessary, the current Medicaid eligibility of the sampled beneficiaries" and making sure the state's eligibility determination systems "have the functionality to verify eligibility requirements and perform eligibility determinations in accordance with federal and state requirements."

The OIG said California did not agree with the office's specific recommendation regarding beneficiaries who may not meet eligibility based on residency. However, after reviewing information presented by the state, OIG auditors found the recommendation to be sound. State officials said in a statement the California Department of Health Care Services agreed with most of the OIG's recommendations and "has taken steps to address all of the findings," according to Kaiser Health News.

 

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