Thousands of out-of-state residents may be receiving benefits under MassHealth, Massachusetts' Medicaid program, and others may not meet the payors' income conditions, according to a report from Massachusetts State Auditor Suzanne Bump.
The audit found that MassHealth does not verify applicants' self-reported income or claims of receiving no income at either the time of application or on a quarterly basis once the enrollee receives MassHealth benefits. The Office of the State Auditor said MassHealth doesn't make its first attempt to verify income until roughly one year after the applicant has been enrolled and received benefits.
The state auditor also says MassHealth has not established a process to verify applicants' residency, but instead accepts applicants' self-declarations of their address. As a result, thousands of people outside Massachusetts may receive benefits inappropriately, according to the report.
"In fact, during our audit, we determined that 71,519 individuals who applied for and received MassHealth benefits during fiscal year 2010 were subsequently terminated by MassHealth, including 38,790 for reasons that bring into question their residency status," according to the report. Of those 38,790, roughly 4,700 received benefits totaling $6.5 million. MassHealth later determined those 4,700 enrollees were either not Massachusetts residents, received benefits in another state or their whereabouts were unknown.
The OSA recommended MassHealth match enrollee data to that from the Massachusetts Department of Revenue and Internal Revenue Service to verify wage information and unearned income. The OSA also recommended more scrutiny for those who report zero household income, such as a requirement that they provide additional information on how they pay for daily living expenses. MassHealth was also urged to match enrollees' residencies with information from the IRS, Social Security Administration, DOR and Division of Employment Security.
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The audit found that MassHealth does not verify applicants' self-reported income or claims of receiving no income at either the time of application or on a quarterly basis once the enrollee receives MassHealth benefits. The Office of the State Auditor said MassHealth doesn't make its first attempt to verify income until roughly one year after the applicant has been enrolled and received benefits.
The state auditor also says MassHealth has not established a process to verify applicants' residency, but instead accepts applicants' self-declarations of their address. As a result, thousands of people outside Massachusetts may receive benefits inappropriately, according to the report.
"In fact, during our audit, we determined that 71,519 individuals who applied for and received MassHealth benefits during fiscal year 2010 were subsequently terminated by MassHealth, including 38,790 for reasons that bring into question their residency status," according to the report. Of those 38,790, roughly 4,700 received benefits totaling $6.5 million. MassHealth later determined those 4,700 enrollees were either not Massachusetts residents, received benefits in another state or their whereabouts were unknown.
The OSA recommended MassHealth match enrollee data to that from the Massachusetts Department of Revenue and Internal Revenue Service to verify wage information and unearned income. The OSA also recommended more scrutiny for those who report zero household income, such as a requirement that they provide additional information on how they pay for daily living expenses. MassHealth was also urged to match enrollees' residencies with information from the IRS, Social Security Administration, DOR and Division of Employment Security.
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