Reviews were conducted during 1975 and 1976 of systems for managing spend-down payments for the medically needy in New York, Maryland, California, the District of Columbia, and as a followup, in Illinois. Spend-down payments, provided by some States under Medicaid for those with incomes above a State-prescribed level but with greater medical expenses, are not eligible for Federal financial participation.

New York and Illinois have been paying for and improperly claiming Federal assistance for spend-down amounts although procedures existed for collecting these amounts from the medically needy. Improper Federal financial assistance to New York State for expenses at municipal hospitals was estimated at $3 million for a 12-month period. Illinois concurred with a 1975 HEW Audit Agency report on its Medicaid program, but did not meet the report's recommendations and did not plan corrective action until a new Medicaid Management Information System would be operational. Limited reviews at the other locations did not disclose billings for ineligible costs.

Status Legend:

Review Pending-GAO has not yet assessed implementation status.

Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.

Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.

• Review Pending
• Open
• Closed - implemented
• Closed - not implemented

Recommendation for Executive Action

Recommendation: The Administrator of the Social and Rehabilitation Service should: assure that the Federal Government does not reimburse New York and Illinois for ineligible amounts, evaluate billing procedures of other States, and adjust incorrect claims.

Agency Affected:

Status: Closed

Comments: Please call 202/512-6100 for additional information.