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Medicaid Concurrent Eligibility

State Medicaid agencies contract with managed care organizations (MCOs) to make services available to enrolled Medicaid beneficiaries. The contractual arrangement shifts financial risk for the cost of care to the MCO. State Medicaid agencies pay MCOs on a per-beneficiary per-month basis, and MCOs are at financial risk if the costs of care exceed those payments. If a beneficiary who resides in one State subsequently establishes residency in another State, the beneficiary's Medicaid eligibility in the previous State should end and the MCO should not receive payments for that beneficiary. Our review will determine whether States made capitation payments on behalf of beneficiaries who established residency in another State.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed (partial) Centers for Medicare & Medicaid Services Medicaid Concurrent Eligibility Office of Audit Services A-05-19-00023;
A-05-19-00031;
A-05-19-00032;
W-00-19-31539;
W-00-21-31539;
W-00-21-35726;
A-05-20-00025;
A-05-21-00028;
W-00-22-31539;
W-00-23-31539;
W-00-24-31539;
A-05-22-00018		 2025