California is required to reimburse the federal government approximately $53 million due to inaccurately claiming Medicaid reimbursements for noncitizens, as revealed in a recent federal audit. The state’s miscalculations have led to financial repercussions, especially as California faces a significant budget deficit amounting to billions of dollars. The audit highlighted the importance of adhering to federal guidelines when claiming reimbursements for noncitizen medical care, emphasizing the restrictions in place for treating foreign nationals who do not meet specific requirements.
Despite these limitations, states like California can still expand their Medicaid programs to provide additional coverage for certain noncitizens, as long as the funding is entirely sourced from the state government. In California’s case, the Medi-Cal program has been instrumental in offering coverage to illegal immigrants, showcasing the state’s commitment to healthcare accessibility.
The report revealed that California utilized a specific formula to ascertain the expenditure of its Medi-Cal program on “nonemergency services” for illegal immigrants and other noncitizens not covered by the federal government. This amount was then deducted from the total spent on emergency care, resulting in a calculated price tag that was reimbursed under Medicaid. However, federal auditors discovered that the calculation method employed by California was inaccurate and had not been updated for several years. The report further disclosed that California “improperly” claimed $52.7 million out of the nearly $373 million in Medicaid reimbursements for noncitizens who did not meet the federal threshold, during the period from October 2018 to June 2019.
“California improperly claimed $52.7 million in Federal Medicaid reimbursement because it continued to use the proxy percentage that was developed in the early 2000s without assessing whether the percentage correctly accounted for the costs of providing nonemergency services to noncitizens with UIS under managed care,” the audit found. “In addition, California did not have any policies and procedures for assessing and periodically reassessing the proxy percentage.”
The audit suggested that California officials should reimburse the federal government and collaborate with regulators to ascertain the extent of incorrect claims made in previous years not included in the audit. This report surfaced shortly after Governor Gavin Newsom, a Democrat from California, declared numerous spending cuts to address a state deficit of nearly $45 billion. The proposed budget cuts encompassed various areas such as healthcare workforce, housing development, education facilities, scholarships, and other initiatives.
“The Department of Health Care Services (DHCS) does not contest the findings of the report by the Office of Inspector General (OIG) and plans to repay the federal government in full by June 30, 2024,” DHCS said in a statement to the Daily Caller News Foundation. “Additionally, DHCS has 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.”
