Some Medicaid recipients may not have been eligible at the time they received services, a state audit of the Oklahoma Health Care Authority released Thursday says, but how many and at what cost is unclear.
State Auditor and Inspector Cindy Bird said the audit did identify almost $30 million — less than 1% of total expenditures — paid on behalf of children who were not eligible for the program.
Byrd also said the audit did not find any evidence the state Medicaid system is being used by noncitizens.
The audit, ordered more than a year ago by Gov. Kevin Stitt, was released following an announcement by Stitt that he intends to revamp the Medicaid system and five days before Oklahomans vote on State Question 802, which would expand Medicaid to more low-income workers.
Stitt opposes SQ 802.
Thursday’s audit, though, didn’t seem to advance either Stitt’s plans to turn Medicaid over to private management or to discourage SQ 802.
When a reporter said the audit did not appear to turn up anything big, Stitt said, “I tell my team, if it’s more than a ham sandwich, let’s fix it.”
The audit report’s primary findings seemed to be that the Health Care Authority too often approves Medicaid benefits before eligibility is thoroughly investigated, and does not verify eligibility of Medicaid clients as often as it should.
Byrd noted that in many cases Oklahoma confirms eligibility within 24 hours — the only state to do so — while federal guidelines allow up to 45 days.
Stitt and Health Care Authority Administrator Kevin Corbitt suggested the approval process should perhaps be slowed down to assure “only those eligible become members of Medicaid.”
The audit report recommends the Health Care Authority access the Federal Data Services Hub, a database created by the Affordable Care Act to verify eligibility for the ACA’s subsidized health insurance program.
In Oklahoma, very few qualify for Medicaid outside of children, pregnant women and people who are blind, elderly or disabled. Nevertheless, as much as one-fourth of the state’s population receives some sort of Medicaid benefit each year.
For decades lawmakers, governors and administrators have struggled with balancing the cost/benefit of strict enforcement.
The Centers for Medicare and Medicaid Services, the federal agency overseeing those programs, has consistently ranked Oklahoma’s Medicaid program among the most efficient in the country.
The Oklahoma Policy Institute, an advocate for Medicaid expansion, said, “The data presented during the briefing doesn’t immediately appear to align with findings from previous state and federal audits, which occur frequently and rigorously.
“Gov. Stitt did not present a clear path on how to address issues from the audit findings. The lack of clarity about a plan to address the findings — combined with the governor’s ongoing silence about the future of his SoonerCare 2.0 proposal — signal that lawmakers and elected officials continue to lack a deliverable vision for health care in Oklahoma.”