A limited audit of women prisoners at
Findings by the state's Medicaid inspector general indicated the problem was tied to
The inspector general, who works for the attorney general, examined jail records for the two populous counties and revealed improper Medicaid payments to managed care companies for women transferred to TCF who ought to have had lost coverage in county jail.
"The current KDOC-Medicaid data matching process does result in errors. It's not foolproof," said
Fertig said KDHE's hiring of
"KDHE has not clawed back those payments from the MCOs that were meant to cover those individuals," Fertig said. "It's pretty black and white. If you are living in a prison or a jail, you are categorically ineligible."
In addition, the audit said, KDHE's current policy of requiring at least 10 days' written notice before terminating inmate eligibility for Medicaid was inconsistent with federal and state regulations.
KDHE agreed to make use of information from
However, Swartz said KDHE would place "under consideration" the idea of invoking the state's contractual right to recoup inadvertent payments to MCOs for persons determined ineligible due to their incarceration status.
The limited audit by the inspector general, which didn't look at men inmates in prisons or jails, revealed three-fourths of 230 cases in which a Medicaid-eligible woman was admitted to TCF during the year resulted in proper steps being taken to sever an individual from the public health program. In the 54 other cases, eligibility was discontinued late or not at all. About half resulted from a paperwork backlog in July, August and
The report said $26,500 of the improper payments to MCOs were related to when women inmates were in county jail prior to transfer to TCF and the remaining $159,000 linked to inmates at the Topeka prison.
"The most extreme case involved a beneficiary who was booked into jail in 2018 and transferred to TCF seven months later," Fertig said. "We found no indication that the clearinghouse was ever aware of her incarceration. That resulted in 11 months of Medicaid eligibility and $3,100 in capitation payments while the beneficiary was incarcerated."