Evidence record
Kansas Medicaid and CHIP Eligibility Determinations Audit
- Jurisdiction
- Kansas
- Publishing agency
- Centers for Medicare & Medicaid Services
- Publication date
- August 1, 2023
- Source record
- Original document linked
Findings
5
Recommendations
8
Overall conclusion
The audit found that Kansas generally complies with eligibility determination requirements but identified significant areas for improvement, especially in documentation, timely case closure, and resource verification. The improper payments highlight the need for enhanced oversight and process improvements to ensure compliance and reduce improper expenditures.
Scope
The audit covered Kansas Medicaid and CHIP eligibility determinations from September 2019 through February 2020, including case reviews, verification processes, and compliance with federal and state regulations.
Findings (5)
Each finding has a stable link.
- F-099
Kansas correctly determined Medicaid eligibility for 88% of sampled beneficiaries and CHIP eligibility for 84.16%.
- F-101
Identified errors included delayed case closures, resource miscalculations, and eligibility misclassifications.
- F-102
Kansas did not always verify resources or income correctly, and sometimes failed to request necessary documentation.
- F-103
There were instances of late case closures and incorrect eligibility category placements.
- F-100
Improper payments for Medicaid totaled $156,916, and for CHIP totaled $23,950, with an estimated total of $9,672,119 in improper payments for CHIP during the audit period.
Recommendations (8)
- R-118
Train case workers on income calculation and eligibility determination.
Related finding F-102 - R-119
Perform annual renewals for Medicaid and CHIP eligibility.
Related finding F-099 - R-120
Identify and document private, third-party health coverage.
- R-121
Ensure correct eligibility category placement.
Related finding F-103 - R-122
Verify all elements of eligibility before making determinations.
Related finding F-102 - R-115
Ensure timely processing of changes in circumstance.
Related finding F-101 - R-116
Verify and accurately calculate income and resources.
Related finding F-102 - R-117
Take timely actions to close cases no longer requiring services.
Related finding F-103