Series: Medicaid Managed Care Capitation Payments on Behalf of Incarcerated Enrollees

OBJECTIVE

States contract with Medicaid managed care organizations to provide specific services to Medicaid enrollees, usually in return for a predetermined periodic payment known as a capitation payment. Section 1905 of Title XIX of the Social Security Act, 42 CFR § 435.1009, and guidance from CMS state that Federal financial participation is generally not available for services provided to adult inmates of public institutions except when the individual is not in a prison setting and becomes an inpatient in a medical institution. We will determine whether select States made unallowable capitation payments to Medicaid managed care organizations on behalf of individuals incarcerated in State prisons.

There are 6 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (6)

TIMELINE

• July 15, 2024
  Series Number SRS-A-25-024 Assigned
• July 15, 2024
  Project Announced

  Project A-05-24-00019

• April 23, 2025
  Project Announced

  Project OAS-25-04-100

• June 16, 2025
  Project Announced

  Project OAS-25-04-117

• June 30, 2025
  Project Announced

  Project OAS-25-05-119

• October 15, 2025
  Project Announced

  Project OAS-25-02-074

• November 5, 2025
  Project Announced

  Project OAS-26-05-013

• Today
  6 Audits In-Progress
• Est FY2026
  Estimated Fiscal Year for Series Completion

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