|Financial Audit Division||Released December 14, 2018|
During calendar year 2017, the Minnesota Department of Human Services (DHS) paid nearly $1.8 billion for health insurance coverage for approximately 297,000 people who were enrolled in the Medical Assistance (MA) category “adults without children.” MA covers individuals who meet certain eligibility requirements. DHS oversees the MA eligibility processes, which require applicants and enrollees to report accurate income and other information to county agencies.
As required by Minnesota Statutes 2018, 3.972, subd. 2a(b), the Office of the Legislative Auditor conducted this audit to determine whether persons enrolled in Medical Assistance were eligible to receive benefits under the program. The 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 Medical Assistance population included in our audit scope. DHS and county agencies calculated eligibility accurately in most of the samples we tested, based on information provided by applicants and enrollees at the time of the review. However, DHS provided Medical Assistance to some sampled enrollees who did not meet eligibility criteria for the program at some point during 2017.
Finding 1. Some Medical Assistance 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. DHS made overpayments to managed care organizations for some Medical Assistance enrollees who were no longer eligible for the program.
Finding 3. DHS did not place some Medical Assistance enrollees in the correct eligibility category, which resulted in incorrect payments to managed care organizations.