Department of Health and Human Services

Office of Inspector General -- AUDIT

"Medicaid Payments for Services Provided to Beneficiaries With Concurrent Eligibility in California and Arizona for July 1, 2005, Through June 30, 2006 - California Department of Health Care Services," (A-05-07-00058)

April 14, 2008


PDF File Complete Text of Report is available in PDF format (1.77 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

We found that California made Medicaid payments on behalf of beneficiaries who should not have been eligible in California because they were eligible in Arizona.  If a resident of one State subsequently establishes residency in another State, the beneficiary’s Medicaid eligibility in the previous State should end.  States’ Medicaid agencies must promptly redetermine eligibility when they receive information about changes in a beneficiary’s circumstances that may affect eligibility.  California made the payments because it did not share all available Medicaid eligibility information with Arizona.  As a result, for the period July 1, 2005, through June 30, 2006, we estimate that California paid $154,470 ($77,235 Federal share) for Medicaid services provided to beneficiaries who should not have been eligible to receive benefits.

We recommended that California work with Arizona to share available Medicaid eligibility information for use in (1) determining accurate beneficiary eligibility status and (2) reducing the amount of payments, estimated to be $154,470 ($77,235 Federal share), made on behalf of beneficiaries residing in Arizona.  California generally agreed with our recommendations.