LDH Not Using Federal or State Tax Data to Verify Medicaid Expansion Recipients' Eligibility

An evaluation of the Louisiana Department of Health’s processes for determining the eligibility of the Medicaid expansion population found the Department did not use federal and/or state tax data to verify information about applicants’ income or household size.

This is the second of two reports focused on how the Department determines whether Medicaid expansion applicants are eligible. The first report, which was released November 8, 2018, examined the Department’s wage verification process.

For this report, auditors tested a random sample of 60 recipients over the period between July 2017 and February 2018. They found that for all 60 recipients the Department did not use federal and/or state tax data to verify applicants’ self-attested tax filer status and household size or to verify certain types of income, including self-employment income, out-of-state income, and various unearned income. Based on the federal definition of improper payments, the Centers for Medicare and Medicaid Services could consider all of the related payments to these individuals improper.

In looking further into the 60 recipients, auditors confirmed that at least five (8 percent) of the 60 were ineligible for Medicaid, based on issues identified with the eligibility determination process. The Department made per member per month payments totaling $60,586 to the managed care organizations that oversee the Medicaid program on behalf of these five recipients.

If these results were projected to the 220,292 Medicaid expansion recipients considered for this report, the Department paid per member per month fees for 17,623 Medicaid recipients who did not qualify for coverage. The testing results suggest that if its Medicaid eligibility determination policies and processes were strengthened, the Department could avoid spending at least approximately $111 million each year.