Supplemental Security Income Overpayments to Medicaid Nursing Home Residents Can Be Reduced

HRD-77-131: Published: Aug 23, 1977. Publicly Released: Aug 23, 1977.

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When recipients of Supplemental Security Income (SSI) enter nursing homes, their payments should be reduced because Medicaid pays the cost of nursing home care.

In 1975, overpayments of about $7.6 million were made to SSI recipients in California and Florida because the Social Security Administration (SSA) did not know that the recipients had been admitted to nursing homes. The majority of these overpayments could have been prevented through timely reporting of nursing home admissions. Social Security regulations require the recipient, or person authorized to accept his payments, to report admissions, but only percent of admissions reviewed by GAO were reported. The regulations do not establish other methods for obtaining the information. Some SSA district offices, on their own initiative, made informal arrangements with nursing homes to report admissions, and with proper encouragement, this was found to be an effective means of obtaining timely reports.

Recommendation for Executive Action

  1. Status: Closed

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

    Recommendation: The Commissioner of SSA should: require the district offices to provide forms to nursing homes for reporting admissions; and actively work with the nursing homes to obtain timely reports. The Administrator of the Health Care Financing Administration should have the States establish procedures requiring nursing homes participating in the Medicaid program to report admissions of recipients to district offices promptly.

    Agency Affected:


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