Most of New Jersey's Claims for Medicaid Supported Employment Services Were Unallowable

Most of the New Jersey Department of Human Services' (State agency) claims for Federal Medicaid reimbursement for supported employment services (in the community care waiver (CCW) program) did not comply with certain Federal and State requirements. Specifically, the State agency claimed Medicaid reimbursement for unallowable supported employment services during 137 of the 139 beneficiary-months in our random sample. The State agency properly claimed Medicaid reimbursement for all supported employment services during the remaining 2 beneficiary-months. On the basis of our sample results, we estimated that the State agency improperly claimed at least $6.9 million in Federal Medicaid reimbursement for unallowable supported employment services.

Supported employment services are ongoing support services and other appropriate services needed to support and maintain individuals with developmental disabilities for whom competitive employment at or above the minimum wage is unlikely and who, because of their disabilities, need intensive ongoing support to perform in a work setting. The State agency's Division of Developmental Disabilities (division) administers the CCW program.

The claims for unallowable services were made primarily because the division and most providers did not ensure that supported employment services were documented or provided by approved personnel to eligible beneficiaries.

We recommended that the State agency refund $6.9 million to the Federal Government and ensure that it complies with certain Federal and State requirements by requiring the division and/or providers to (1) claim reimbursement only for documented supported employment services, (2) provide supported employment services only to beneficiaries for whom there is a completed and approved care plan, (3) ensure and document that all job coaches meet division qualifications, and (4) ensure and document that all beneficiaries approved for supported employment services have been assessed and certified to need the required level of care. The State agency partially concurred with our first recommendation and described actions that it had taken or planned to take to address the remaining findings and recommendation.