Review of Child Delivery Claims and Newborn Claims Included in the Kansas 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 Kansas, the Kansas Health Policy Authority (the State agency) is responsible for administering the Medicaid program. The amount of funding that the Federal Government reimburses to State Medicaid agencies, known as either Federal financial participation (FFP) or Federal share, is determined by the Federal medical assistance percentage (FMAP), which varies based on a States relative per capita income. The State agencys FMAP rate ranged from 59.43 percent to 68.31 percent for claims paid from July 1, 2005, through June 30, 2009. Our objective was to determine whether the child delivery and newborn claims submitted by providers and claimed by the State agency at the 90-percent FFP rate from July 1, 2005, through June 30, 2009, qualified as family planning services pursuant to Federal requirements.