Evidence record
New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements
- Jurisdiction
- New Jersey
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- September 2025
- Source record
- Original document linked
Findings
5
Recommendations
2
Overall conclusion
New Jersey did not ensure that the State agency adequately monitored and ensured compliance by its MCOs and fiscal intermediary with Federal and State requirements for PPP PCA services; as a result, the program was vulnerable to misuse of Federal funds and the health and safety of PPP participants may have been placed at risk.
Scope
Audit covered 387,526 Medicaid ABD participant-months (CY 2019–2021) with 150 participant-months sampled; reviewed MCO and fiscal intermediary documentation to verify compliance with PCA assessments, monthly budgets, cash plans, caregiver verification, and OIG LEIE verifications; estimated noncompliant payments.
Findings (5)
Each finding has a stable link.
- F-1264
The State agency did not ensure that its contracted MCOs and fiscal intermediary complied with Federal and State requirements for providing PCA services to selected PPP participants.
- F-1265
MCOs did not meet PCA assessment and monthly budget amount requirements for 24 of the 150 sampled participant-months.
- F-1266
The fiscal intermediary did not meet cash plan and caregiver verification requirements for 55 of the 150 sampled participant-months.
- F-1267
On the basis of the sample results, the audit estimated that for 41 percent of participant-months during the audit period, MCOs paid caregivers through the fiscal intermediary for PCA services provided under the PPP that did not comply with Federal and State requirements, totaling approximately $196,584,979.
- F-1268
These deficiencies occurred because the State agency did not adequately monitor the MCOs and fiscal intermediary, leaving the program vulnerable to misuse of Federal funds and potentially placing PPP participants health and safety at risk.
Recommendations (2)
- R-1114
Require MCOs to revise procedures to (1) maintain PCA assessments, (2) complete PCA reassessments annually, (3) maintain monthly budget amounts, and (4) update monthly budget amounts in accordance with applicable PCA assessments.
Related finding F-1265 - R-1115
Require the fiscal intermediary to revise procedures to (1) document participants' cash plans, (2) populate accurate information on cash plans, (3) document all services to be provided in participants' cash plans, and (4) complete and document OIG LEIE verifications for caregivers.
Related finding F-1266