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Galloway Audit Finds Problems With How Missouri Confirmed Medicaid Eligibility

A new audit found problems with how Missouri’s Medicaid system determined whether a participant in the health care program is still eligible.

Federal regulations require state Medicaid programs to check on someone’s eligibility every 12 months. State Auditor Nicole Galloway’s audit, released on Thursday, found Missouri’s system that examined eligibility was error-prone and incorrectly removed people from the program.

When changes were made to that system, Galloway’s audit still found that there were numerous eligibility inaccuracies. As a result, determinations about whether people were still eligible for Medicaid were delayed for months, if not years, after a due date.

“Our review of eligibility documentation for 60 participants, of which 45 required a redetermination, identified four participants for which eligibility redeterminations were not performed as required and one ineligible participant for which the case was not closed in the claims payment system,” the audit states. “These errors represent approximately 9% and 2% of the participants reviewed.”

The audit reviewed the program as of June 30, 2019. It comes as lawmakers in Jefferson City have given a greater focus to how tens of thousands of people, mainly children, were dropped from Medicaid coverage since the beginning of 2018.

After the coronavirus outbreak, the Department of Social Services, which oversees the state’s Medicaid program, announced it “will not terminate eligibility for any Medicaid participant unless the individual requests a voluntary termination of eligibility or the individual ceases to be a resident of the state through the end of the federal emergency COVID-19 declaration.” That’s part of federal legislation that passed earlier this month.

In response to the audit, the Department of Social Services stated: “We agree with the auditor's finding. Our corrective action plan includes our planned actions to address the finding.”

“Corrective action planned is as follows: The DSS is developing a monthly report to identify overdue reviews,” the department wrote within the audit. “DSS will analyze the reporters to determine if additional policy or systems updates are necessary.”

Galloway’s examination of Missouri’s Medicaid eligibility system was part of a broader look on how the state spends federal money.

Follow Jason on Twitter: @jrosenbaum

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