Medicaid Claims for Federal Reimbursement Using Managed-Care Proxy Methodology

OBJECTIVE

Federal health care benefits are generally allowable when provided to a beneficiary who is a U.S. citizen, U.S. national, or qualified alien. Generally, a qualified alien is ineligible for full-scope Medicaid services before 5 years have passed from the date he or she enters the United States with qualifying status (5-year bar).Medicaid eligibility for most qualified aliens who are subject to the 5-year bar is generally limited to emergency services (restricted-scope services).States may choose to provide full-scope services to qualified aliens who are subject to the 5-year bar using their own State funds. Furthermore, States may choose to cover full-scope services to aliens permanently residing in the United States under color of law and to children under the age of 19 regardless of immigration status. However, the costs related to nonemergency services provided to non-citizens in these groups without satisfactory immigration status are not eligible for Federal reimbursement. We will review whether States properly claimed Federal Medicaid reimbursement related to services provided to non-citizens who lacked satisfactory immigration status.

TIMELINE

• May 9, 2022
  Announced
• May 17, 2024
  Complete

  Medicaid Claims for Federal Reimbursement Using Managed-Care Proxy Methodology has been marked as complete. This audit resulted in 2 recommendations.

REPORT PUBLISHED

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