Utah Generally Operated Its Medicaid Estate Recovery Program in Accordance With Requirements and in a Cost Effective Manner, but Utah Did Not Have Formal Written Procedures

Why OIG Did This Audit

• All States are required to have a Medicaid Estate Recovery Program (MERP) that seeks, from the estates of deceased Medicaid enrollees who were 55 years old and older when they received medical assistance, reimbursement for certain Medicaid costs such as long-term care (e.g., nursing homes).
• As part of its oversight activities, OIG is auditing Medicaid estate recovery to determine whether States are operating their MERPs in accordance with requirements and the extent to which States’ MERPs were cost effective.
• This audit examined whether: (1) Utah operated its MERP in accordance with Federal and State requirements and (2) Utah’s MERP was cost effective.

What OIG Found

Utah generally operated its MERP in accordance with Federal and State requirements in that it performed required estate recovery procedures for 85 of the 100 deceased Medicaid enrollees in our stratified random sample.

• Our audit also identified 15 enrollee cases for which, because of an absence of supporting documentation, we could not determine whether Utah performed any estate recovery procedures.
• We also identified 3 enrollee cases that Utah had opened between 12 and 14 years before the start of our audit, but for which the State had not performed any periodic monitoring.

The deficiencies that we identified occurred because Utah did not have formal written policies and procedures for its estate recovery program, and because Utah’s estate recovery system edits did not always work as intended.

We also concluded that Utah’s MERP was cost effective.

What OIG Recommends

We made three procedural recommendations to Utah for the improvement of its estate recovery program, including that it establish formal written estate recovery policies and procedures, to include policies and procedures regarding documentation; that it implement formal procedures to periodically review open cases; and that it verify that system edits are functioning properly and improve those edits as necessary, and verify that caseworkers perform and document all applicable estate recovery procedures. The full recommendations are in the report.

Utah concurred with all of our recommendations and described corrective actions that it had taken and planned to take to address them.

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