The state of California recently agreed to repay over $52 million in improperly claimed Medicaid reimbursements for noncitizens with unsatisfactory immigration statuses, as determined by a federal inspector general. The audit, conducted by the Department of Health and Human Services, covered more than $372 million in federal Medicaid reimbursements made on behalf of noncitizens during fiscal year 2019. Examples of qualified noncitizens include refugees, people granted asylum, and those lawfully admitted for permanent residence, while federal Medicaid benefits are typically limited to citizens and qualified noncitizens. The inspector general identified an outdated calculation metric as a contributing factor to the improper claims.
The California Department of Health Care Services acknowledged the inspector general’s findings and plans to repay the federal government in full by June 30, 2024. They have also worked with the federal Centers for Medicare & Medicaid Services to develop a more refined service identification methodology with updated payment and claiming processes. The audit noted that California’s state Medicaid program, MediCal, casts a wider coverage net than the federal government for noncitizens with unsatisfactory immigration statuses. While MediCal covers full-scope services for these individuals, California can only claim federal reimbursement for emergency services, requiring them to pay for nonemergency services using state funds. The state had been using a CMS-approved methodology related to claiming costs for providing full-scope Medi-Cal coverage to noncitizens with unsatisfactory immigration statuses, applying a proxy percentage to capitation payments made to Medicaid managed care plans on their behalf.
The federal Medicaid agency first requested an audit, and in May 2020, the state agency informed the feds that they had mistakenly claimed federal reimbursement. Illegal immigrants are ineligible for federal “ObamaCare” coverage overall, according to HealthCare.gov. The audit highlights the importance of ensuring that Medicaid funds are claimed and utilized appropriately and in accordance with federal requirements. The repayment of over $52 million by California demonstrates a commitment to rectifying the improperly claimed reimbursements and implementing processes to prevent similar issues in the future. Moving forward, the state will continue to work with federal agencies to refine their identification methodology and payment processes to align with federal guidelines. Overall, the findings of the audit underscore the need for states to carefully manage and monitor Medicaid reimbursements to prevent financial discrepancies and ensure that funds are directed towards eligible individuals and services.
