California will have to repay more than $52 million to the federal government for improperly requiring some immigrant patients to receive reimbursements from Medicaid, according to a recent report by federal inspectors.
The findings from the U.S. Department of Health and Human Services Office of Inspector General come as California faces a $44.9 billion deficit.
However, state officials said the refunds were factored into California’s budget plan, which includes various spending cuts. HD Palmer, deputy director for external affairs at the California Department of the Treasury, said this would not trigger further cuts.
With the exception of emergency care, states generally are not allowed to claim Medicaid reimbursement for immigrants who do not meet federal requirements. The federal government refers to the banned group as “noncitizens with ineligible immigration status,” a category that does not include refugees, immigrants who have been granted asylum or are legally allowed to remain permanently under federal law.
Despite these limitations, states can expand their Medicaid programs to provide additional services that are funded entirely by states rather than the federal government. California has gradually expanded its Medicaid program, known as Medi-Cal, to provide coverage to immigrants in the country without legal authorization.
Under its plan, it pays managed care plans a fixed amount each month to each Medi-Cal enrollee. California uses a formula to determine how much of those payments are for “non-emergency services” for immigrant patients not covered by the federal government, then subtracts that amount from the total to calculate the amount for emergency care that can be reimbursed under Medicare. Grant program.
California said the federal government approved the calculation method “sometime in the early 2000s,” but could not provide any records showing it was approved, according to the inspector general’s office report.
A federal audit found that California improperly claimed $52.7 million from October 2018 to June 2019 of nearly $373 million in Medicaid reimbursements for immigrants who did not meet federal requirements. Investigators say the scheme did not accurately reflect the proportion of emergency services costs over the years.
The inspector general’s office recommended that California return the funds and work with federal regulators to determine how much federal funds may have been improperly claimed in other years not covered by the audit. A spokesman for the Centers for Medicare and Medicaid Services said the federal agency was aware of the report and “we are working with California to address the issues raised by the audit.”
California’s Department of Health Care Services said it would not dispute the findings, although the federal audit noted that it was “unable to replicate” the recalculations federal auditors performed to arrive at the refund amounts. The state agency said it “plans to repay the federal government in full by June 30.”
The California department also said it is working with the Centers for Medicare and Medicaid Services to develop “better” methods and “updated payment and claims processes.”
