Review of New Jersey's Medicaid School-Based Rates. Final Report

摘要

Congress amended section 1903(c) of the Social Security Act in 1988 to permit Medicaid coverage of health-related services provided to children pursuant to Part B of the Individuals with Disabilities Education Act. The Medicaid school-based program allows Medicaid reimbursement for health-related services and administrative costs. In 1993, New Jersey began to claim Medicaid reimbursement for health-related services through a program called the Special Education Medicaid Initiative (SEMI) program. In July 1998, New Jersey began claiming administrative costs through a program called the Medicaid Administrative Claiming (MAC) program. From July 1, 1998, through June 30, 2001, the State received Federal Medicaid payments of $101 million for the SEMI program and $77 million for the MAC program. Our objective was to determine whether the rates used by New Jersey to claim Federal Medicaid reimbursement under the SEMI and MAC programs were reasonable and complied with Federal requirements and the Medicaid State plan. The rates used by New Jersey to claim Federal Medicaid reimbursement under the SEMI and MAC programs were not reasonable and did not comply with Federal requirements and the Medicaid State plan. The SEMI and MAC rate-setting methodologies included costs that were duplicated, unallowable, or improperly allocated. As a result, the State improperly received Federal Medicaid payments during the period July 1, 1998, through June 30, 2001. These improper payments were not quantified because a prior Office of Inspector General audit report (Report Number A-02-03-01003) questioned school-based claims billed by New Jersey for the same period.