Purpose

To determine the extent of implementation of the five recommendations included in our initial audit report, Under Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments (Report 2010-S-17).

Background

Our initial audit report, issued on September 28, 2011, examined whether Medicaid payments to nursing homes were properly reduced by Medicaid recipients' net available monthly income. Many Medicaid nursing home recipients have income from Social Security, pensions and other sources to offset the cost of their nursing home care. This is referred to as net available monthly income (NAMI). New York's 58 localities (county social service offices throughout the State and the Human Resources Administration in New York City) are responsible for determining NAMI amounts for their Medicaid nursing home recipients. Localities are also responsible for updating the Department's Medicaid claims processing system (eMedNY) with recipients' NAMI. During claims processing, eMedNY deducts NAMI from the amount that Medicaid pays each month to nursing homes. For the period January 1, 2007 through August 31, 2010, auditors estimated that Medicaid overpaid nursing homes about $42 million due to system flaws within eMedNY and because localities did not update NAMI in a timely manner. Our initial audit report contained recommendations for the Department of Health to recover overpayments made to nursing homes and improve controls over properly applying NAMI toward the cost of nursing home care.

Key Finding

Department of Health officials made progress in addressing some of the problems we identified. This included the recovery of $46 million. However, further actions are still needed. Of the initial report's five recommendations, three were implemented and two were not implemented.

Key Recommendation

Officials are given 30 days after the issuance of the follow-up review to provide information on any actions that are planned to address the unresolved issues discussed in this review.

Other Related Audit/Report of Interest

Department of Health: Under Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments (2010-S-17)