Evidence record
New York Medicaid Managed Care Capitation Payments for Incarcerated Enrollees
- Jurisdiction
- New York
- Audit organization
- U.S. Department of Health and Human Services, Office of Inspector General, Office of Audit Services
- Publication date
- September 2026
- Source record
- Metadata record
Findings
3
Recommendations
2
Overall conclusion
New York made unallowable managed care capitation payments totaling $7,551,670 ($6,164,734 Federal share) on behalf of 1,375 incarcerated Medicaid enrollees and did not consistently disenroll incarcerated enrollees; recommendations include refunding the Federal share and strengthening enrollment matching controls.
Scope
Audit covered January 1, 2021 through December 31, 2024; $7.6 million in capitation payments to MCOs for 1,375 incarcerated enrollees; matched DOCCS prison data to T-MSIS/WMS; evaluated internal controls and policies for disenrollment.
Findings (3)
Each finding has a stable link.
- F-1445
The State agency made unallowable managed care capitation payments totaling $7,551,670 ($6,164,734 Federal share) on behalf of all 1,375 incarcerated Medicaid enrollees.
- F-1446
The State agency did not always disenroll incarcerated enrollees from Medicaid managed care after notification of incarceration, due to system limitations and overrides during the COVID-19 Public Health Emergency (PHE).
- F-1447
In some cases, minor differences in enrollees' demographic information prevented identification of incarcerated individuals, leading to continued capitation payments.
Recommendations (2)
- R-1293
Refund $6,164,734 (Federal share) for unallowable capitation payments.
Related finding F-1445 - R-1294
Strengthen policies and procedures to prevent system limitations that may lead to Medicaid capitation payments for incarcerated enrollees and to account for minor differences in enrollees' demographic information when matching DOCCS prison data to Medicaid enrollment data in the Welfare Management System (WMS).
Related finding F-1446