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Michigan Did Not Perform Eligibility Redeterminations at Least Every 12 Months for Wayne County Medicaid Beneficiaries

The State Medicaid agency and its agent, the County Human Services agency, did not make eligibility redeterminations at least every 12 months for Medicaid beneficiaries who were continuously enrolled during our audit period.

From a random sample of 200 Medicaid beneficiaries, the State Medicaid agency performed eligibility redeterminations within the required 12-month period for 142 beneficiaries. However, the State Medicaid agency made payments to providers on behalf of 58 beneficiaries who were subject to annual redeterminations, but for whom the County Human Services agency did not perform eligibility redeterminations within the required 12-month period. Although the County Human Services agency had information for the cases that were due for redetermination, it did not complete all redeterminations pursuant to Federal and State requirements. For the period October 1, 2008, through September 30, 2010, we estimate that the State Medicaid agency was reimbursed for Medicaid services provided to 79,277 beneficiaries whose eligibility redeterminations were not performed within the required 12-month period.

Filed under: Centers for Medicare and Medicaid Services