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CALIFORNIA MADE MEDICAID PAYMENTS ON BEHALF OF NEWLY ELIGIBLE BENEFICIARIES WHO DID NOT MEET FEDERAL AND STATE REQUIREMENTS

April 24, 2019

This report is a study by the Office of Inspector General which looked at a sample of 150 Medicaid beneficiaries in California to see if they actually qualified for benefits.

"On the basis of our sample results, we estimated that California made Medicaid payments of $738.2 million ($628.8 million Federal share) on behalf of 366,078 ineligible beneficiaries and $416.5 million ($402.4 million Federal share) on behalf of 79,055 potentially ineligible beneficiaries. (These estimates represent Medicaid payments for fee-for- service, managed-care, the drug treatment program, and mental health services.) These deficiencies occurred because California’s eligibility determination systems lacked the necessary system functionality and eligibility caseworkers made errors."