A recent audit conducted by the Department of Health and Human Services found that California had improperly claimed more than $52 million in Medicaid reimbursements for noncitizens with unsatisfactory immigration statuses. Federal Medicaid benefits are typically limited to citizens and qualified noncitizens, such as refugees, asylees, and lawful permanent residents. The audit covered over $372 million in federal Medicaid reimbursements made on behalf of noncitizens in fiscal year 2019, with $52.7 million not filed for in accordance with federal requirements.
The inspector general attributed part of the issue to an outdated calculation metric. In response to the findings, the California Department of Health Care Services plans to repay the federal government in full by June 30, 2024. They have also worked with the federal Centers for Medicare & Medicaid Services to develop and implement a more refined service identification methodology with updated payment and claiming processes. MediCal, California’s state Medicaid program, covers a wider range of services for noncitizens than the federal government, casting a wider net when it comes to coverage.
Even though MediCal offers full-scope services for noncitizens with unsatisfactory immigration statuses, California is only able to claim federal reimbursement for emergency services provided to these individuals. Nonemergency services would typically have to be paid for using state funds. The report outlined that the California Department of Health Care Services had been using a longstanding, CMS-approved methodology related to claiming costs for providing full-scope Medi-Cal coverage to noncitizens with unsatisfactory immigration statuses but had erroneously claimed federal reimbursement. The federal Medicaid agency requested the audit, and the state agency admitted its mistake in May 2020.
It is important to note that illegal immigrants are ineligible for federal “ObamaCare” coverage, according to HealthCare.gov. This highlights the complex regulations surrounding healthcare coverage for noncitizens with varying immigration statuses. The audit findings shed light on the need for accurate and compliant claiming processes in order to prevent improper reimbursements. By working with federal agencies to refine their methodology, California aims to ensure that future Medicaid reimbursements are in line with federal requirements and that the state remains in good standing with the federal government.
