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Audit Audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Taunton Enrollment Center

The audit shows MassHealth has addressed significant deficiencies in the verification of both reported income and residency, problems that were identified in a 2012 audit by the Auditor’s office. The audit examined the period of January 1, 2017 through December 31, 2018.

Organization: Office of the State Auditor
Date published: October 9, 2020

Executive Summary

The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program. This program, known as MassHealth, is administered under Chapter 118E of the Massachusetts General Laws by the Executive Office of Health and Human Services, through the Division of Medical Assistance. Medicaid is a joint federal-state program created by Congress in 1965 as Title XIX of the Social Security Act. At the federal level, the Centers for Medicare & Medicaid Services, within the United States Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.

To assist individuals who want to apply for MassHealth benefits for the first time or renew their existing benefits, MassHealth operates four enrollment centers, located in Tewksbury, Chelsea, Taunton, and Springfield. Employees at these enrollment centers are responsible for collecting all of the necessary information and documentation from each applicant and verifying, as required, that each applicant meets all of the program’s eligibility requirements related to assets, income, residency, and citizenship. A person or his/her authorized representative must file an application online, complete a paper application, complete a telephone application, or walk into one of the enrollment centers and complete an application with the staff.

During fiscal year 2019, OSA initiated an audit of MassHealth’s four enrollment centers to determine whether employees at the centers properly verified the incomes of walk-in applicants. In this audit, we reviewed the asset/income-related eligibility verification activities that MassHealth conducted at its Taunton enrollment center for the period January 1, 2017 through December 31, 2018. During this period, the Taunton enrollment center performed income verification procedures for 5,741 walk-in applicants. This audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program.

Our audit revealed no significant instances of noncompliance by MassHealth’s Taunton enrollment center that must be reported under generally accepted government auditing standards.

 

A PDF copy of the audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Taunton Enrollment Center is available here.

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