Review of State Children's Health Insurance Program Eligibility in Florida

EXECUTIVE SUMMARY:

From January 1 through June 30, 2005, the State agency (1) made some State Children's Health Insurance Program (SCHIP) payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements and (2) did not always adequately document eligibility determinations.  For the 6-month audit period, we estimated that the State agency made SCHIP payments totaling between $18,776,786 and $32,583,603 (Federal share) on behalf of ineligible beneficiaries and that case file documentation did not adequately support eligibility determinations for an additional payments totaling between $4,130,356 and $11,568,962 (Federal share). 

We recommended that the State agency use the results of this review to help ensure compliance with Federal and State SCHIP eligibility requirements by (1) reemphasizing to Florida Healthy Kids Corporation (FHKC) employees the need to adequately verify eligibility information, (2) minimizing the time period between determination of Medicaid eligibility and disenrollment of the applicant from SCHIP, and (3) reemphasizing to FHKC employees the need to maintain appropriate documentation in all case files. We also recommended that the State agency work with CMS to resolve the estimated improper payments of at least $18,776,786 identified in the review. Neither FHKC nor the State agency specifically addressed these recommendations.