Audit: Florida made Medicaid payments for patients also enrolled in other states

(The Center Square) — A recent report from the U.S Department of Health and Human Services’ Office of the Inspector General showed that Florida had made Medicaid payments on behalf of thousands of residents who were also enrolled in Medicaid programs in other states.

Managed care organizations in Florida are paid by the state for services they make available to eligible Medicaid enrollees, an expense that is paid monthly by the state at a fixed rate.

Previous audits by OIG had found that state Medicaid agencies had made improper capitation payments, this prompted concern about the future of Florida’s Medicaid program being negatively impacted and this concern was the catalyst for the latest report.

In August 2020, OIG found that Florida had made Medicaid payments totaling $15.8 million for 55,164 enrollees, who were simultaneously enrolled in the program in another state.

The OIG sampled 100 enrollees, and the results showed that 44% of those enrollees resided outside of Florida and those 44 out-of-state enrollees cost the Sunshine State $22,624 each in capitation payments.

The enrollees living out of Florida, according to the report, were spread across the U.S., with the majority of them residing in Pennsylvania and Ohio and as far away as Puerto Rico.

The Public Assistance Reporting Information System, run through the Administration for Children and Families, is responsible for providing quarterly information in various services, including those enrolled in Medicaid, to identify any anomalies with enrollment.

The audit found two major issues.

The first issue was that Florida was not notified when an enrollee had moved and had enrolled in Medicaid in another state. There were several instances of people changing states and enrolling there, but the state was never notified.

The second issue is that some of the enrollees continued to receive Medicaid after they had already opted out of the program. Several enrollees told auditors they notified Florida that they were permanently leaving for other states but were still enrolled in the Florida Medicaid program.

According to the report, part of the trouble occurred during the COVID-19 pandemic and relaxed rules on Medicaid eligibility played a major part in the breakdown of communication.

The report also noted that one enrollee who had relocated to Oregon, had Medicaid payments from Florida continue until December 2021, after notifying the state they were relocating in March 2020.

In the report’s conclusion, August of 2020 was an expensive month for Florida, which essentially lost $6.9 million in that month alone. The estimated cost over an entire year for unnecessary Medicaid payments was over $82 million.

The report concluded that while the COVID-19 public health emergency was declared, states were restricted from terminating an enrollee’s Medicaid eligibility unless the enrollee specifically requested to terminate their enrollment.

Previous audits, however, point out that this was a problem for Florida before the PHE, according to the report.

The OIG recommended that the Florida Agency for Health Care Administration, “resume and enhance procedures that are in accordance with Federal requirements and the state’s unwinding plan to identify and disenroll enrollees who are residing and enrolled in Medicaid managed care in another state when the PHE ends.”

Furthermore, the OIG recommended that Florida work more closely with the Centers for Medicaid & Medicaid Services to better identify potential cases of multiple enrollments.