Medicaid Capitation Payments Made on Behalf of Incarcerated Individuals
States contract with Medicaid managed care organizations to provide specific services to enrolled Medicaid beneficiaries, usually in return for a predetermined periodic payment, known as a capitation payment. Section 1905 of Title XIX of the Social Security Act, 42 CFR § 435, and guidance from the Centers for Medicare & Medicaid Services state that Federal financial participation is not available for services provided to inmates of public institutions, except when the inmate is not in a prison setting and becomes an inpatient in a medical institution. We will determine whether select States made unallowable capitation payments to Medicaid managed care organizations on behalf of individuals who were incarcerated.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|October 2018||Centers for Medicare & Medicaid Services||Medicaid Capitation Payments Made on Behalf of Incarcerated Individuals||Office of Audit Services||W-00-18-31534; various reviews||2019|