Texas Medicaid Audit Reports
Review Medicaid audit findings, recommendations, and oversight activity for Texas. Use this page to jump into report summaries or continue exploring the full library.
Recent Reports
An Actuarial Analysis Of The Health And Human Services Commission’s Fiscal Year 2024 Medicaid Managed Care Rates Actuarial Soundness
The FY 2024 Texas Medicaid managed care capitation rates are actuarially sound overall, with no material program-wide under- or over-funding detected. Milliman identifies several recommendations to st...
An Audit Report on the Health and Human Services Commission's Medicaid Managed Care Rate-Setting Process
Milliman concluded that FY2023 capitation rates were actuarially sound, with no program-wide pattern of under- or over-funding, though improvements were recommended in several rate-setting and governa...
An Audit Report on Cook Children’s Health Plan, a Managed Care Organization
Cook Children’s Health Plan accurately reported STAR Kids medical and pharmacy expenses in FY 2020 and complied with eligibility requirements for medical and pharmacy claims. However, improvements are...
An Audit Report on The Health and Human Services Commission’s Oversight of the Medical Transportation Program
The audit identified strengths in some areas but also significant weaknesses that could affect the program's integrity and compliance. The Commission has committed to implementing recommended improvem...
An Audit Report on Blue Cross Blue Shield of Texas, a Managed Care Organization
The audit found that while the Health Plan accurately reported medical, administrative, and quality improvement expenses, its pharmacy expense reporting was flawed due to unallowable practices by the ...
An Audit Report on Medicaid Managed Care Contract Processes at the Health and Human Services Commission
The audit found that the Health and Human Services Commission has made significant progress in establishing processes and controls related to Medicaid managed care contract management, in compliance w...
Medicaid Managed Care Contract Processes at the Health and Human Services Commission
The Commission has made significant progress in establishing processes and controls for Medicaid managed care contract management, aligning with Senate Bill 894 requirements. However, further efforts ...