|Financial Audit Division||Released October 11, 2018|
During calendar year 2017, the Minnesota Department of Human Services (DHS) paid approximately $368 million for health insurance coverage for nearly 132,000 people who were enrolled in MinnesotaCare. MinnesotaCare covers adults without children, parents, and children who are not eligible for other public health care programs and who do not have access to employer-based insurance. DHS oversees and administers the MinnesotaCare eligibility processes, which require enrollees to report accurate income and other information to the department.
As required by Minnesota Statutes 2017, 3.972, subd. 2a(b), the Office of the Legislative Auditor conducted this audit to determine whether persons enrolled in MinnesotaCare were eligible to receive benefits under the program. Our audit scope included eligibility determinations made during calendar year 2017.
We concluded that the Department of Human Services generally complied with eligibility requirements for the MinnesotaCare population included in our audit scope. DHS determined eligibility correctly for the samples we tested, based on information it had obtained at the time of its review. However, due to limitations in eligibility processes, MinnesotaCare coverage was provided to some enrollees who did not meet eligibility criteria for the program at some point during 2017.
Finding 1. Some MinnesotaCare enrollees who were correctly determined eligible for the program did not later report to DHS changes in circumstances; these changes likely would have affected their eligibility if timely reported.
Finding 2. Due to deficiencies in DHS information systems, DHS made overpayments for MinnesotaCare enrollees who were no longer eligible for the program.