Review of Allegheny County's Medicaid Administrative Case Management Costs Claimed by Pennsylvania Between January 2002 and June 2003

摘要

In 1965, Congress established Medicaid as a jointly funded State and Federal program that provides medical assistance to low-income people who qualify pursuant to Title XIX of the Social Security Act (the Act). In the Commonwealth of Pennsylvania, the Department of Public Welfare (Pennsylvania) administers the Medicaid program in accordance with a State plan approved by the Centers for Medicare & Medicaid Services (CMS). In Allegheny County, the Department of Human Services administers mental health programs with oversight by Pennsylvania. Allegheny County reports its expenditures to Pennsylvania, which then submits a claim for Federal matching funds. Included in these claims are administrative case management expenditures. Pennsylvania defines administrative case management as those activities and administrative functions that ensure intake into the mental health system and appropriate and timely use of available resources. Pennsylvania claimed $25.3 million (Federal share) for administrative case management costs. These claims included costs for the period January 1, 2002, through June 30, 2003. For this period, the Federal share for Allegheny County administrative case management expenditures was $6.1 million. The next largest Federal share claimed was $2.5 million for Philadelphia County, the States largest county. CMS requested that we determine the nature of this discrepancy. Our objective was to determine whether administrative case management costs claimed on behalf of Allegheny County were comparable to those costs claimed on behalf of Philadelphia County.