Massachusetts Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements

Why OIG Did This Audit

• In March 2020, Congress enacted the Families First Coronavirus Response Act in response to the COVID-19 public health emergency, which required States to ensure that most individuals were continuously enrolled for Medicaid benefits (enrollees).
• The Consolidated Appropriations Act, 2023, ended the continuous enrollment condition. As a result, States had to conduct renewals, post-enrollment verifications, and redeterminations (Medicaid eligibility actions) for all enrollees.
• This audit is part of a series and examined whether Massachusetts completed Medicaid eligibility actions during its unwinding period in accordance with Federal and State requirements.

What OIG Found

Of the 352,408 enrollees covered during our audit period (April through September 2023), we sampled 140 enrollees and determined that 3 enrollees had their Medicaid eligibility incorrectly determined.

On the basis of our sample results, we estimated that Massachusetts incorrectly renewed Medicaid eligibility for 7,040 of the 190,043 Medicaid enrollees whose eligibility was renewed during our audit period. Additionally, we found that, in its reports to CMS, Massachusetts incorrectly reported on its eligibility actions for eight enrollees in our sample. We also estimated that Massachusetts’ reports to CMS during our audit period incorrectly reported on eligibility actions for 17,749 of 352,408 enrollees.

What OIG Recommends

We made three recommendations to Massachusetts, including that it redetermine eligibility for the three sampled enrollees whose eligibility was incorrectly determined and take appropriate action, provide periodic training to caseworkers, and revise its policies and procedures related to its reports to CMS. The full recommendations are in the report. Massachusetts concurred with our first two recommendations and partially concurred with our third recommendation.