Department of Health

Determining Medicaid Eligibility

Individuals apply for Medicaid benefits at local social services districts (57 counties and New York City). The local districts are responsible for determining whether the applicants are eligible for the benefits, both initially and thereafter. The Department of Health is responsible for overseeing the eligibility determination process. We examined the adequacy of the Departmentís oversight and found that certain improvements were needed. For example, during our 34-month audit period, as much as $6.3 million in Medicaid payments for emergency medical services may have been made to recipients who were not eligible for the services, and $3.6 million in payments were made for services that may have been provided after the recipientís date of death. We recommended these payments be investigated and all overpayments recovered. We also recommended certain actions be taken by the Department to increase the likelihood of preventing or promptly detecting such overpayments in the future.

For a complete copy of Report 2005-S-42 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.