Medicaid Payments for Services Provided to Beneficiaries with Concurrent Eligibility in Georgia and Florida for July 1, 2005, Through June 30, 2006

摘要

Pursuant to Title XIX of the Social Security 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. The Georgia Department of Community Health (State agency) manages the Georgia Medicaid program. Medicaid eligibility in each State is based on residency. If a resident of one State subsequently establishes residency in another State, the beneficiarys Medicaid eligibility in the previous State should end. The State Medicaid agencies must redetermine the eligibility of Medicaid beneficiaries, with respect to circumstances that may change, at least every 12 months. The State Medicaid agencies must have procedures designed to ensure that beneficiaries make timely and accurate reports of any change in circumstances that may affect their eligibility. The State Medicaid agencies must promptly redetermine eligibility when they receive information about changes in a beneficiarys circumstances that may affect eligibility. For the audit period July 1, 2005, through June 30, 2006, the State agency paid approximately $7.9 million for services provided to beneficiaries who were Medicaideligible and receiving benefits in Georgia and Florida. The objective of our review was to determine whether the State agency made payments on behalf of beneficiaries who should not have been Medicaid-eligible due to their eligibility in Florida.