HealthLeaders Media September 21, 2022
John Commins

Auditors say the increase coincided with an overall increase in Medicaid enrollment during the first year of the pandemic.

KEY TAKEAWAYS

– State Medicaid agencies made improper capitation payments for beneficiaries enrolled in Medicare and living in other states totaling $117 million in August 2020, compared with $73 million in August 2019.

– Auditors recommend that the CMS monitor beneficiaries’ concurrent Medicaid MCO enrollments, rather than rely upon individual states to do so.

– CMS acknowledges the problem but did not concur with recommendations that it says could prove “redundant, inefficient, and confusing to states.” 

The value of improper Medicaid capitation payments made by states to managed care providers for beneficiaries who were already enrolled in Medicaid programs in other...

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