Four American states have been highlighted in a recent Office of Inspector General (OIG) report for not having met all necessary requirements to receive expanded federal Medicaid funding during the Covid-19 public health emergency.
The provision in focus during the public health emergency barred states from disenrolling Medicaid beneficiaries, unless they voluntarily disenrolled or left the state. In exchange, states were offered increased federal funding, an increase of 6.2 percentage points from their standard federal medical assistance percentage (FMAP) rates. However, this provision ended in March, with states now returning to typical Medicaid renewal procedures.
The states under OIG’s review include New York, Florida, Texas, and Minnesota. Cumulatively, these states received an extra $12.8 billion in FMAP funding from January 1, 2020, to June 30, 2021. The review entailed the following steps:
- Assessment of public health emergency eligibility policies and procedures.
- Comparison of Medicaid enrollees lists from March 18, 2020, and June 30, 2021.
- Investigation into enrollee terminations.
- Review of cost-sharing for Covid-19 tests, services, and treatment.
- Analysis of premiums to ensure states met requirements.
The audit revealed that all states in question terminated Medicaid coverage for some enrollees on grounds that were “unallowable or potentially unallowable.” Specifically, Texas and Minnesota terminated Medicaid coverage for 26,915 enrollees for unallowable reasons, whereas New York, Florida, and Minnesota ended coverage for 220,113 enrollees for potentially unallowable reasons. The bases for these terminations were deemed potentially unallowable due to a lack of adequate support or documentation from the states to demonstrate that the terminations were permissible.
The OIG also discovered that Minnesota may have improperly charged some Medicaid enrollees cost-sharing for Covid-19 testing, services, and treatment, potentially summing up to $951,202. Nonetheless, Minnesota officials stated that there is not sufficient data to confirm whether this occurred or not, as indicated by the audit.
In light of these findings, the OIG made two recommendations to the Centers for Medicare and Medicaid Services (CMS). Firstly, to ascertain what amount of the expanded Covid-19 funding, received by these states, needs to be refunded. Secondly, to work with Minnesota particularly in understanding whether any Medicaid enrollees experienced cost-sharing for Covid-19 testing, services, or treatments. If any forms of cost-sharing were identified, CMS should ensure the beneficiaries receive proper reimbursement.
According to the OIG, CMS concurred with both recommendations and detailed the forthcoming actions.
Find more details in the original report here.