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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 2020