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New York Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries

New York did not always determine Medicaid eligibility for newly eligible beneficiaries in accordance with Federal and State requirements. In our sample of 130 beneficiaries, New York correctly determined eligibility for 90 beneficiaries. However, it did not determine eligibility for 37 beneficiaries in accordance with Federal and State requirements and did not provide supporting documentation to verify beneficiaries were newly eligible for the remaining 4 potentially ineligible beneficiaries. The total exceeds 130 because 1 beneficiary was found to be ineligible for one determination period and found to be potentially ineligible for another determination period. On the basis of our sample results, we estimated that New York made Federal Medicaid payments of $26.2 million on behalf of 47,271 ineligible beneficiaries.

We recommended that New York (1) redetermine, as appropriate, the current Medicaid eligibility status of the sample beneficiaries and (2) improve the design of its enrollment system to ensure that it maintains applications, verifies income and citizenship eligibility data, and determines eligibility by using available electronic data sources, as appropriate.

New York disagreed with our recommendations and some of our findings and provided additional documentation under separate cover to support its stance on the findings with which it disagreed. New York also requested that we revise some statements in our report and remove information related to our testing of potential changes in Medicaid requirements, which we initially reported as an audit finding. Based on our review of New York's comments and additional documentation, we revised some of our findings and are no longer reporting the information related to our testing of potential changes in Medicaid requirements as an audit finding with a related recommendation. We maintain that our remaining recommendations are valid.

Filed under: Centers for Medicare and Medicaid Services