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New Jersey Did Not Always Claim Medicaid Reimbursement for Medicare Part B Premiums in Accordance with Federal Requirements

The Social Security Act allows State Medicaid programs to enter into an agreement with the Centers for Medicare & Medicaid Services known as the buy-in program. The purpose of the Medicaid buy-in program is to permit States to provide medical insurance protection to designated categories of needy individuals who are eligible for Medicaid and/or meet certain eligibility requirements.

Under the buy-in program, the New Jersey Department of Human Services (DHS) did not always claim Federal Medicaid reimbursement for Medicare premiums in accordance with Federal requirements. Of the 1,167 beneficiaries that we reviewed, DHS properly claimed Federal Medicaid reimbursement for 34 Medicare Part A beneficiaries and 176 Part B beneficiaries. However, DHS improperly claimed Federal Medicaid reimbursement for Medicare Part B premiums paid on behalf of 957 beneficiaries, totaling $524,000.

We recommended that DHS refund $524,000 to the Federal Government, implement procedures to ensure that it does not claim Federal reimbursement for certain Medicare Part B premiums, and work with the New Jersey Department of Health and Senior Services to ensure that it only enrolls individuals in the buy-in program who meet Federal eligibility requirements. DHS partly agreed and partly disagreed with our recommendations.

Filed under: Centers for Medicare and Medicaid Services