Review of Federal Medicaid Claims Made for Beneficiaries in the Family Planning Benefit Program in New York State

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 Medicaid 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 Federal share of the Medicaid program is referred to as Federal financial participation (FFP). Section 1903(a)(5) of the Social Security Act and 42 CFR 433.10 and 433.15 provide enhanced 90-percent FFP for family planning services. According to section 4270 of the CMS 'State Medicaid Manual,' family planning services prevent or delay pregnancy or otherwise control family size. The New York State Legislature enacted the Family Planning Benefit Program (FPBP) as part of Chapter 57 of the Laws of 2000. Chapter 57 added Section 366 (l)(a)(ll) of the Social Services Law to expand eligibility for family planning services to individuals with incomes at or below 200 percent of the Federal poverty level, contingent upon approval of a Federal waiver. FPBP was approved by CMS as an amendment to New York's Section 1115 Partnership Plan Waiver on September 27,2002, with an effective date of October 1, 2002. FPBP provides only Medicaid-reimbursed family planning services, exclusive of abortions, for eligible individuals. No other Medicaid services are eligible for Federal Medicaid reimbursement for beneficiaries in the FPBP. Our objective was to determine if New York State properly received Federal Medicaid reimbursement for claims submitted by providers for beneficiaries in the FPBP.