Review of Medicaid Funding for Emergency Services Provided to Nonqualified Aliens

摘要

In Florida, the Agency for Health Care Administration (State agency) administers the Medicaid program. The State agency reimburses providers for emergency medical services provided to nonqualified aliens under the Emergency Medicaid for Aliens (EMA) program. The Florida Administrative Code, section 409.901(9) and (10), uses the definition of an emergency medical condition contained in Federal regulations. The State agency has policies and procedures for the EMA program that are contained in various policy manuals, which explain the Medicaid for Aliens program, Emergency Medical Condition, Emergency Services and Care, and benefit limits for EMA program. To qualify for the EMA program, an individual must meet all eligibility requirements for the Medicaid program as described in the Florida Department of Children and Families Economic Self-Sufficiency Policy Manual. The Florida Department of Children and Families is responsible for determining the eligibility of the individuals. During our audit period (July 1, 2005, through June 30, 2007), the State agency processed claims totaling approximately 411.7 million (242.3 million Federal share) for medical services provided to undocumented aliens. Our objective was to determine whether the State agency claimed for Federal reimbursement only services for nonqualified aliens that it approved or defined as emergency medical conditions.