Minnesota DHS Provided Medicaid Benefits to Out-of-State and Incarcerated Individuals, Report Finds

A new report issued last week by the Minnesota Office of the Legislative Auditor found that the Department of Human Services (DHS) provided Medical Assistance (MA), or Medicaid, benefits to ineligible residents.

While the report concluded that the DHS “generally complied” with eligibility requirements, there were numerous instances in which enrollees failed to report “changes in circumstances” that “likely would have affected their eligibility.”

For instance, the audit found that “24 enrollees did not timely notify their county agency that they had permanently moved out of state and that MA coverage should have been terminated.”

Additionally, DHS failed to “identify” that one enrollee was “later incarcerated,” and paid $6,308 in “medical payments to a managed care organization while this enrollee was incarcerated.”

The state of Minnesota paid nearly $1.8 billion for health insurance coverage for an estimated 297,000 enrollees in 2017, but last week’s audit found that 15 percent of recipients were ineligible because they exceeded income limits.

“For 15 of 100 sample cases (15 percent), the enrollee’s actual income for calendar year 2017 exceeded their income reported to the county agency and the household income limit set in federal law. Thus, these individuals would not have met income eligibility criteria for MA at some point during 2017,” the report states.

State Sen. Michelle Benson (R-Anoka), chair of the Senate Health and Human Services Finance and Policy Committee, told KSTP that “15 percent is huge when you talk about billions of dollars being spent in human services.”

“When Republicans talk about eliminating waste and fraud, this is the sort of thing we mean. If someone is making too much money they should not be receiving taxpayer-funded benefits,” she said in a statement on Facebook, pointing out that several people received MA benefits but made “nearly double” the maximum income level.

“The Department of Human Services’ continued unwillingness, or inability, to implement fraud prevention efforts that are required under state law is an affront to all Minnesota taxpayers,” State Rep. Joe Schomacker (R-Luverne) said on Twitter. “Taxpayers deserve better.”

In response to the report, DHS Commissioner Emily Piper acknowledged that “in some cases DHS made overpayments for Medical Assistance enrollees who were no longer eligible for the program,” but blamed the mistakes on “county work error, information system deficiencies, and incomplete verification of incarceration status.”

Piper states in her response, which is included in the report, that the DHS is working with Minnesota IT Services to “improve the system deficiencies.”

The report concludes by recommending that the DHS implement more frequent reviews of enrollee eligibility, and examine enrollee data against state information resources to prevent benefits from going to incarcerated individuals.

As Battleground State News reported Wednesday, the DHS is also under intense scrutiny by lawmakers for failing to provide answers on the rampant childcare fraud in Minnesota.

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Anthony Gockowski is managing editor of Battleground State News and The Minnesota Sun. Follow Anthony on Twitter. Email tips to [email protected].
Photo “Women in Jail” by Officer Bimblebury. CC BY-SA 4.0.







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