Review of Family Planning Service Costs Claimed by Delaware's Medicaid Managed Care Program

EXECUTIVE SUMMARY:

Our objective was to determine whether Delaware Health and Social Services (Delaware) claimed family planning service costs under its Medicaid managed care program in accordance with its CMS-approved methodology and Federal statutes, regulations, and guidelines.  We could not validate Delaware's family planning service rates, which were based on fee-for-service claims incurred between July 1, 1991, and June 30, 1994, because Delaware did not provide documentation to support its calculations.  Because Delaware could not justify its calculation of family planning service costs, it was not entitled to the $2.9 million enhanced Federal share.

We recommended that Delaware (1) provide support for family planning service costs claimed between October 2000 and June 2004 or refund $2,916,288 to the Federal Government and (2) work with CMS to determine the amounts claimed for family planning service costs after June 2004, refund the enhanced portion to the Federal Government, and discontinue claiming family planning service costs at the enhanced rate until it provides adequate support for its family planning rates.  In comments, Delaware did not agree that was required to refund enhanced reimbursement, based on its belief that CMS had previously approved supporting documentation.