Situation Report | August 8, 2022
Last week, the New York State Comptroller’s office released an audit of managed long term care (MLTC) plans for the period January 2015 to March 2021, which found:
- Medicaid paid about $701 million in improper MTLC premium payments on behalf of 52,397 recipients who were no longer eligible for MLTC enrollment (did not receive services, deceased, in hospital for more than 45 days, not Medicaid eligible or not eligible for MLTC services).
- Medicaid paid $2.8 billion in MLTC premium payments on behalf of 51,947 recipients who received a limited number of community-based long-term care services; for instance, 22,048 recipients only received between 1 and 30 days of services during six-month assessment periods.
The Comptroller recommends that the state Department of Health (DOH) should review the $701 million in premium payments and make any appropriate recoveries; develop a process to ensure timely MLTC disenrollment of ineligible recipients; and monitor MLTC recipients to ensure that they are properly assessed for enrollment and are receiving the appropriate level of care.
HCA will be reviewing the audit findings, but notes that DOH calculates plan premiums to cover individuals who may need few services and those who need frequent services; part of the audit period covered the COVID-19 pandemic which affected the delivery of services; unclear DOH guidance on service termination; and the unknown future effects of changing the assessment process to utilize the New York Independent Assessor.