BC Advantage - 2024 Issue 8

California Made Capitation Payments for Enrollees Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Another State

Why OIG Did This Audit   California pays managed care organizations to make services available to eligible Medicaid enrollees in return for a monthly fixed payment (capitation payment) for each enrollee. Previous OIG audits found that state Medicaid agencies made capitation payments on behalf of enrollees who were residing and enrolled in Medicaid in another state. This audit assessed whether California made capitation payments on behalf of Medicaid enrollees who were concurrently enrolled in a Medicaid managed care program in another state.   What OIG Found   On the basis of our sample results, we estimated that California incurred...

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