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Boston — State Auditor Suzanne Bump today issued an audit of MassHealth, which found the process for verifying self-reported income and residency information needs improvements and may be costing the Commonwealth millions of dollars annually in Medicaid expenses.
MassHealth, with expenditures of over $12 billion, provides access to healthcare services for approximately 1.3 million eligible low- and moderate-income individuals annually. MassHealth is the state’s largest program, accounting for almost a third of the state budget. Today’s audit report examined how MassHealth determines an individual’s eligibility for the program.
“The values of the people of Massachusetts have been reflected in the universal health insurance law which has resulted in our state leading the nation in the percentage of people with health insurance,” said Auditor Bump. “Our commitment, coupled with the economic downturn, has led more people than ever before to turn to MassHealth for public assistance with their health care. It is my duty as State Auditor to ensure that MassHealth has the strongest possible safeguards in place to protect both the taxpayers and people in need. This audit today indicates that more needs to be done.”
The audit has three findings:
During fiscal year 2010 MassHealth provided health care benefits totaling over $12 million to 15,999 individuals who presented MassHealth with foreign passports or temporary visas. Even though the residency information provided by these members directly conflicts with their federal status as temporary visitors, MassHealth does not have a process for resolving their resident status.
Among other recommendations, Auditor Bump has called on MassHealth to leverage existing information held by the Internal Revenue Service, the Massachusetts Department of Revenue, Social Security, and the Department of Unemployment Assistance to verify submitted income and residency information at the time of application.
The Office of State Auditor Suzanne Bump conducts financial, performance, and technical assessments of state government’s programs, departments, agencies, authorities, contracts, and vendors. With its reports, the OSA issues recommendations to improve accountability, efficiency, and transparency.
The audit of MassHealth's Eligibility Determination Process for Healthcare Services is available here.