Review of the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program in Nebraska

For the quarter ended March 31, 2009, the majority of the Medicaid costs that the Nebraska Department of Health & Human Services (State agency) claimed, which totaled approximately $413 million (approximately $273 million Federal share), was adequately supported by actual recorded expenditures. However, the State agency allocated inpatient hospital services as family planning services, which received a 90-percent enhanced rate (enhanced rate) of Federal reimbursement, through an allocation methodology which State agency officials could not explain and for which State agency officials could provide neither supporting documentation nor evidence that the Centers for Medicare & Medicaid Services had approved that methodology. For the quarter ended March 31, 2009, the State agency received $44,000 in Federal reimbursement for family planning services at the enhanced rate, and we were unable to determine what portion of this amount was allowable. We also identified several weaknesses in the procedures used by the State agency to calculate and claim Medicaid costs. Under the provisions of the American Recovery and Reinvestment Act of 2009, the State of Nebraska's Federal medical assistance percentage (FMAP) for Medicaid expenditures increased from 59.54 percent (its Federal fiscal year 2008 FMAP) to 65.74 percent for the quarter ended March 31, 2009.