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The Louisiana Legislative Auditor says five of 60 Medicaid recipients it studied, or eight percent, did not qualify for the program. Auditors say the results suggest the state has been making payments on behalf of thousands of Medicaid participants who should have been ruled ineligible.
The report, released Monday, is the auditor’s second review of the Louisiana Department of Health’s eligibility verification process following the expansion of Medicaid under Gov. John Bel Edwards. As with the first report, LDH largely agreed with the auditor’s findings and recommendations and said a new eligibility-verification system will address the problems.
Auditors - Sample - Adults - Medicaid - Program
Auditors reviewed a sample of 60 adults who participated in the expanded Medicaid program between July 2017 and February 2018. For all 60 recipients, auditors found, LDH did not utilize federal or state tax data to verify recipients’ tax filer status and household size or to verify certain types of income, such as self-employment or out-of-state income.
"We consider the department’s decision to not use tax data a weakness in internal control because tax data is the only trusted source for these critical Medicaid eligibility factors," the auditors say. "Based on the federal definition of improper payments, [Medicaid’s federal regulator] could consider all related payments improper."
Auditors - LDH - Payments - Care - Organizations
Auditors found LDH made payments totaling $60,586 to managed care organizations on behalf of five ineligible people in its 60-person sample. Using their sample as a guide, auditors say LDH likely made payments on behalf of 17,623 recipients out of an expansion population of 220,292. While they didn’t venture an estimate of how much the department spent on those recipients, they said LDH could save $111 million annually with better eligibility controls.
The report also says that for some recipients, LDH allowed caseworkers to renew eligibility without contacting the recipients, failed to retain signed Medicaid applications, and allowed people to apply on...
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