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Press Release MassHealth Has Made Improvements to Applicant Income Eligibility Verifications, Audit Shows

Recommendations in 2012 audit of MassHealth have been implemented.
For immediate release:
10/09/2020
  • Office of the State Auditor

Media Contact for MassHealth Has Made Improvements to Applicant Income Eligibility Verifications, Audit Shows

Noah Futterman

An image of a stethoscope and a pen from a doctors office

BostonToday, State Auditor Suzanne M. Bump released a series of four audits examining MassHealth enrollment centers. The audits show the agency 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 audits released today examined the practices at enrollment centers in Chelsea, Springfield, Taunton, and Tewksbury. During the audit period (January 1, 2017 through December 31, 2018) the four enrollment centers processed 26,476 walk-in MassHealth benefit applications.

“Audits serve as tools to help agencies more effectively serve their clients and make better use of taxpayer money. MassHealth has made tremendous strides in ensuring that only eligible residents can gain access to this program,” said Bump. “The changes that have been made make full use of the verification technology made available by the federal Medicaid program and have improved program integrity.”

The audits released today found the MassHealth enrollment centers were properly comparing income information provided by applicants to official data sources, including those maintained by the Internal Revenue Service, the Massachusetts Department of Revenue, and the Social Security Administration, to ensure accuracy and determine whether the applicants qualified for benefits. To qualify for MassHealth, an individual’s or family’s earned and unearned income cannot exceed a designated percentage of the federal poverty level.

Bump initially called on MassHealth to use these official data sources to confirm self-reported applicant income information in a 2012 audit. That audit showed the agency waited approximately one year after enrollment to independently verify member income, which may have allowed ineligible applicants to receive benefits for up to one year, costing taxpayers of the Commonwealth significant money unnecessarily.

MassHealth is administered by the Executive Office of Health and Human Services, through the Division of Medical Assistance. The state’s Medicaid program annually provides access to healthcare for approximately 1.9 million eligible low- and moderate-income children, families, seniors, and people with disabilities. In FY18, MassHealth paid providers more than $15 billion, of which 50 percent was funded by the Commonwealth. Medicaid expenditures represent approximately 39 percent of the state’s total annual budget.

The audit of the MassHealth Chelsea Enrollment Center is available here.

The audit of the MassHealth Springfield Enrollment Center is available here.

The audit of the MassHealth Taunton Enrollment Center is available here.

The audit of the MassHealth Tewksbury Enrollment Center is available here.

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Media Contact for MassHealth Has Made Improvements to Applicant Income Eligibility Verifications, Audit Shows

Office of the State Auditor 

The Office of State Auditor Suzanne M. Bump (OSA) conducts audits, investigations, and studies to promote accountability and transparency, improve performance, and make government work better.
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