New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements

Why OIG Did This Audit

• New Jersey’s Medicaid Personal Preference Program (PPP) allows Medicaid participants to self-direct their personal care assistant (PCA) services and remain in their home and active in their community without requiring the use of a home health care agency.
• New Jersey pays managed care organizations (MCOs) fixed monthly payments to make PCA services available under the PPP. MCOs must assess participant eligibility using a PCA assessment and provide a monthly budget amount to be used for services. New Jersey contracts with a fiscal intermediary to provide a range of services for participants. The fiscal intermediary assists in establishing a cash plan for the participant and verifies that caregivers are eligible to provide services.
• This audit examined whether New Jersey ensured that its contracted MCOs and fiscal intermediary complied with Federal and State requirements for providing PCA services to selected PPP participants.

What OIG Found

New Jersey did not ensure that its contracted MCOs and fiscal intermediary complied with Federal and State requirements for providing PCA services to selected PPP participants. Specifically:

• MCOs did not meet PCA assessment and monthly budget amount requirements for 24 of the 150 sampled participant-months.
• The fiscal intermediary did not meet cash plan and caretaker verification requirements for 55 of the 150 sampled participant-months.
• On the basis of our sample results, we estimated that, for 41 percent of participant-months during the audit period, MCOs paid caregivers $197 million through the fiscal intermediary for PCA services provided under the PPP that did not comply with Federal and State requirements.

What OIG Recommends

We made two procedural recommendations to New Jersey to improve its oversight and monitoring of its Medicaid PPP. The full recommendations are in the report. New Jersey concurred with our recommendations.