New Hampshire Did Not Always Correctly Claim Medicaid Payments for School-Based Transportation Services

The New Hampshire Department of Health and Human Services, Office of Medicaid Business and Policy (State agency), did not always claim Federal Medicaid reimbursement for school-based transportation services submitted by school administrative units (SAU) in accordance with Federal and State requirements during calendar years 2006 through 2009. Of the 115 items in our random sample, 37 items met Federal and State requirements. However, the remaining 78 items had 1 or more school-based transportation services that were not reimbursable. Based on our results, we estimated that the State agency improperly claimed $5 million ($2.7 million Federal share) for Medicaid payments made to SAUs.

The deficiencies occurred because the State agency issued incorrect guidance to the SAUs based on its misunderstanding of Federal requirements. In addition, the State agency did not adequately monitor the claims for Medicaid school-based transportation services submitted by SAUs.

We recommended that the State agency (1) refund $2.7 million to the Federal Government, (2) work with CMS to review Medicaid payments made to SAUs after our audit period and refund any overpayments, (3) strengthen its oversight of the New Hampshire Medicaid to Schools program to ensure that claims for school-based transportation services comply with Federal and State requirements, and (4) issue new guidance on school-based transportation that is consistent with Federal requirements. The State agency concurred in part and disagreed in part with our findings and recommendations.