California will return $52 million to the federal government for wrongly claimed immigrant Medicaid payments.
The state of California has recently come under fire for improperly claiming over $52 million in Medicaid reimbursements for noncitizens with unsatisfactory immigration statuses. This revelation came as a result of an audit conducted by the Department of Health and Human Services, under the watchful eye of Inspector General Christi Grimm. The audit, which covered more than $372 million in federal Medicaid reimbursements made on behalf of noncitizens during fiscal year 2019, found that $52.7 million of that sum was not filed in accordance with federal requirements.
According to federal guidelines, Medicaid benefits are typically reserved for citizens and “qualified” noncitizens, such as refugees, individuals granted asylum, or those lawfully admitted for permanent residence. However, California’s state Medicaid program, MediCal, extends coverage to noncitizens with unsatisfactory immigration statuses beyond what federal regulations allow. This broader coverage net has led to the state claiming federal reimbursement for services that should have been paid for using state funds.
The audit highlighted an outdated calculation metric as one of the primary causes of this discrepancy. In response to the findings, the California Department of Health Care Services (DHCS) has committed to repaying the federal government in full by June 30, 2024. Additionally, DHCS is working with the Centers for Medicare & Medicaid Services to develop and implement a more refined service identification methodology with updated payment and claiming processes to prevent future errors.
The report also pointed out that, in May 2020, the California Department of Health Care Services informed the federal Centers for Medicare & Medicaid Services that it had been using a longstanding methodology approved by CMS for claiming costs related to providing full-scope Medi-Cal coverage to noncitizens with unsatisfactory immigration statuses. This methodology involved applying a proxy percentage to capitation payments made to Medicaid managed care plans on behalf of these noncitizens.
The federal Medicaid agency initiated the audit after the state agency admitted to erroneously claiming federal reimbursement. The audit’s findings have raised concerns about the potential misuse of Medicaid funds and the need for better oversight and compliance with federal guidelines. It serves as a reminder of the importance of ensuring that taxpayer dollars are used appropriately and in accordance with established regulations.
It is important to note that illegal immigrants are not eligible for federal “ObamaCare” coverage, according to HealthCare.gov. This underscores the need for clarity and consistency in determining eligibility for public assistance programs and the proper allocation of resources to those who are lawfully entitled to receive them.
In conclusion, the audit’s findings reveal significant lapses in the proper claiming of federal Medicaid reimbursements for noncitizens with unsatisfactory immigration statuses in California. The state’s commitment to repay the funds and implement corrective measures is a step in the right direction towards ensuring accountability and transparency in the management of Medicaid benefits. It is essential for all involved parties to work together to address these issues and prevent similar errors in the future, ultimately safeguarding the integrity of the Medicaid program and the taxpayers’ trust.
