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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

Department of Health
Medicaid Program: Oversight of Localities' Efforts to Coordinate Veterans' Health Care Benefits Under Medicaid and the U.S. Department of Veterans Affairs


Issued: March 19, 2014
Link to full audit report 2012-S-162
Link to 90-day response

Purpose
To determine whether the Department of Health effectively oversaw localities' efforts to coordinate veterans' health care benefits provided through Medicaid and the U.S. Department of Veterans Affairs (VA). The audit covers the period April 1, 2008 through October 31, 2013.

Background
Many of New York's Medicaid recipients are veterans. During the five-year period ending March 31, 2013, New York's Medicaid program reimbursed health care providers $3.47 billion for medical services provided to more than 70,000 veterans. Many veterans enrolled in Medicaid are also entitled to health care benefits through the VA. While it is a veteran's choice to use a VA health care benefit or a Medicaid benefit, the Department of Health (Department) has acknowledged that significant cost savings could be realized by assisting veterans and coordinating their health care benefits through the VA. As part of the State's Medicaid eligibility process, veterans must be identified and referred to the State Division of Veterans' Affairs (State DVA) or local veterans' service agencies (local VSA) so they can file for federal benefits. Such referrals are critical for enhancing the coordination of veterans' Medicaid and VA benefits, as well as for helping ensure veterans access all federal benefits they are entitled to.

Key Findings

  • The Department did not effectively oversee localities' efforts to coordinate veterans' Medicaid and VA health benefits. A review of case records at counties with high Medicaid expenses for veterans showed that referrals to the State DVA/local VSA were not made in 81 of 91 (or 89 percent) of the cases tested. Further, local departments of social services did not use available resources to identify veterans and coordinate their health care benefits between Medicaid and the VA.
  • We believe the Medicaid savings to State and local taxpayers could be several millions of dollars annually, if the localities did a better job coordinating veterans' Medicaid and VA health benefits.
  • The Department has not used the federal Public Assistance Reporting Information System (PARIS) to identify veterans' spouses and dependents eligible for VA health care benefits.
  • In accordance with the Affordable Care Act, the Department implemented the New York Health Benefit Exchange. However, the Department has not developed a method to inform veterans applying for Medicaid through the new Exchange of their VA benefits.

Key Recommendations

  • Enforce Medicaid policies regarding the coordination of veterans' health care benefits between Medicaid and the VA; ensure all referrals are made in order to maximize veterans' health care benefits.
  • Improve the utility of pertinent tools and resources to identify veterans and veterans' spouses and dependents who may be eligible for VA health care benefits.

Other Related Audits/Reports of Interest

Department of Health: Inappropriate Payments for Medicaid Recipients Residing and Enrolled in Other States (2008-S-4)


State Government Accountability Contact Information:
Audit Director: Brian Mason
Phone: (518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236