Simplifying the Medicare/Medicaid Buy-In Program Would Reduce Improper State Claims of Federal Funds

HRD-79-96: Published: Oct 2, 1979. Publicly Released: Oct 2, 1979.

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A study of the Medicare/Medicaid buy-in program was based on a review of pertinent Federal laws, regulations, policies, and procedures on the Medicare and Medicaid programs, with emphasis on the buy-in aspect; a review of applicable State regulations, policies, and procedures relating to the buy-in program, with emphasis on state procedures for claiming Federal sharing; and discussions with Federal and State officials.

The Department of Health, Education, and Welfare's (HEW) Health Care Financing Administration (HCFA) is responsible for administering Medicare and Medicaid. The Medicaid buy-in program allows States to enroll Medicaid recipients for partial Medicare coverage and pay for their premiums, permitting participating states to transfer some medical costs from their Federal/State-financed Medicaid program to the federally financed Medicare program. The Federal Government only shares in premium costs for individuals enrolled in Medicare and receiving actual cash assistance or cash assistance as defined for buy-in purposes. At the time of the study, 5 States had no buy-in program, 21 bought in cash assistance recipients, and 27 bought in cash and noncash assistance recipients. Administrative responsibilities for each group differed accordingly. A review of the claims of 10 States revealed that all except one improperly claimed Federal sharing, and other procedures in that State violated Federal law and regulations. The complexity of Federal buy-in regulations, lack of uniformity in State practices, and poor HEW monitoring of States' buy-in programs were blamed for the system's shortcomings.

Matter for Congressional Consideration

  1. Status: Closed

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

    Matter: Congress should amend the Social Security Act to simplify buy-in program administration and improve the accuracy of States' claims for Federal Medicaid sharing.

Recommendation for Executive Action

  1. Status: Closed

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

    Recommendation: The Secretary of HEW should direct the Administrator, HCFA, to enforce the requirements of Federal law and regulations by: (1) monitoring more closely States' administration of the program, periodically validating claims for Federal sharing; (2) collecting moneys due the Federal Government from States identified as having overclaimed and paying States identified as having underclaimed; and (3) providing more assistance to States in carrying out their buy-in programs.

    Agency Affected:

 

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