Review of Costs for Inpatient Services in the Colorado Medicaid Family Planning Program

摘要

Pursuant to Title XIX of the Social Security Act (the Act), the Medicaid program provides medical assistance to low-income individuals and individuals with disabilities. The Federal and State Governments jointly fund and administer the Medicaid program. At the Federal level, the Centers for Medicare & Medicaid Services (CMS) administers the program. Each State administers its Medicaid program in accordance with a CMS-approved State plan. Although the State has considerable flexibility in designing and operating its Medicaid program, it must comply with applicable Federal requirements. In Colorado, the Department of Health Care Policy and Financing (the State agency) is responsible for administering the Medicaid program. The amount that the Federal Government reimburses to State Medicaid agencies, known as Federal financial participation (FFP) or Federal share, is determined by the Federal medical assistance percentage (FMAP), which varies based on a State's relative per capita income. The State agency's FMAP rates ranged from 50.00 percent to 61.59 percent for claims paid during Federal fiscal years (FY) 2006 through 2009 (October 1, 2005, through September 30, 2009). Federal requirements also allow for various specified services to be reimbursed at higher FFP rates. Section 1903(a)(5) of the Act and 42 CFR SCSC 433.10(c)(1) and 433.15(b)(2) authorize Federal reimbursement at an enhanced 90-percent rate (90-percent rate) for family planning services. Section 4270 of the CMS State Medicaid Manual describes family planning services as those that prevent or delay pregnancy or otherwise control family size. The objective was to determine whether the State agency claimed costs for family planning inpatient services during FYs 2006 through 2009 pursuant to Federal and State requirements.