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Audit (A-04-09-03046)

09-15-2010
Review of Concurrently Enrolled State Children's Health Insurance Program and Medicaid Beneficiaries in Florida From April 1, 2007, Through March 31, 2008

Executive Summary

Based on our sample results, we estimated that from April 1, 2007, through March 31, 2008, Florida claimed $5.3 million in Federal financial participation (FFP), or matching funds, for State Children's Health Insurance Program (SCHIP, now known as CHIP) enrollees who were concurrently enrolled in SCHIP and Medicaid for a total 65,121 enrollment-months. If an individual is eligible for Medicaid, he or she is ineligible for SCHIP. The Federal Government uses enhanced Federal medical assistance percentages (FMAP) to determine the amount of FFP for State expenditures in SCHIP. The concurrent enrollments occurred primarily because (1) Medicaid enrollment can be retroactive for up to 3 months, during which time the individual may also have been enrolled in SCHIP, and (2) the State agency's partners did not have adequate internal controls to prevent or correct concurrent enrollments promptly.

We recommended that the State (1) make a financial adjustment of $5.3 million on Form CMS-21 for FFP claimed on behalf of SCHIP enrollees who were also enrolled concurrently in Medicaid, (2) make regular financial adjustments on future Forms CMS-21 to correct FFP claimed on behalf of SCHIP enrollees who are enrolled concurrently in Medicaid, and (3) develop additional policies and procedures to prevent or recoup SCHIP payments made on behalf of individuals who are enrolled concurrently in Medicaid. The State disagreed with our overall findings.

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