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Review of Consumer-Directed Personal Care Assistance Program in New Jersey (PPP)

Announced on  | Last Modified on  | Project Number: A-02-22-01024
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicaid Consumer-Directed Personal Assistance Programs provide an alternative way of receiving home care services in which consumers have more control over who provides their care and how it is provided. Rather than assigning a home care agency that controls selection, training, and scheduling of aides, the consumer, or the family member, friend, or guardian directing his or her care, performs all these functions usually done by the agency. Eligible individuals include those eligible for services provided by a certified home health agency, a long-term home health care (waiver) program, AIDS home care program, or personal care (home attendant). Prior OIG work has shown vulnerabilities in personal care programs resulting in ineligible beneficiaries and Medicaid payments that do not comply with Federal and State regulations. We will determine whether selected States made Medicaid payments for consumer-directed personal assistance program claims in accordance with applicable Federal and State regulations.

TIMELINE

  • September 14, 2022
    Announced
  • September 17, 2025
    Complete

    Review of Consumer-Directed Personal Care Assistance Program in New Jersey (PPP) has been marked as complete. This audit resulted in 2 recommendations.

REPORT PUBLISHED

New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements (A-02-22-01024)

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.

25-A-02-119.01 to CMS - Open Unimplemented
Update expected on 03/16/2026
We recommend that the New Jersey Department of Human Services improve its oversight and monitoring of its New Jersey Medicaid PPP by requiring MCOs to revise their procedures to include: (1) maintaining PCA assessments, (2) completing PCA reassessments annually, (3) maintaining monthly budget amounts, and (4) updating monthly budget amounts in accordance with applicable PCA assessments.

25-A-02-119.02 to CMS - Open Unimplemented
Update expected on 03/16/2026
We recommend that the New Jersey Department of Human Services improve its oversight and monitoring of its New Jersey Medicaid PPP by requiring the fiscal intermediary to revise its procedures to include: (1) documenting participants' cash plans, (2) populating accurate information on cash plans, (3) documenting all services to be provided in participants' cash plans, and (4) completing and documenting OIG LEIE verifications for caregivers.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship
Target Groups
-
Financial Groups
Medicaid