NCJ Number
72833
Date Published
1979
Length
69 pages
Annotation
This report highlights problems in the medicare/medicaid buy-in program which result in improper State claims for Federal sharing.
Abstract
Because administering medicaid's program to enroll its recipients in medicare is so difficult, the Federal Government overpays some States and underpays others. Under the Social Security Act which authorizes medicaid and medicare, States can enroll (buy-in) eligible medicaid recipients in medicare. The buy-in provisions give States the opportunity to shift the costs of some medical services to the Federal Government. The Department of Health, Education, and Welfare (HEW), charged with Federal oversight responsibility, has provided little assistance to States in carrying out their buy-in programs and has inadequately monitored States' compliance with Federal regulations and proper claim sharing. The General Accounting Office (GAO) believes that there are a number of ways Federal law could be changed to simplify buy-in program administration and reduce States' improper claiming of Federal sharing and has suggested options for congressional modification of the law. Until and unless the law is changed, HEW should enforce current requirements by monitoring more closely States' administration of the program and periodically validating claims for Federal sharing. HEW should also collect moneys due the Federal Government from States identified as having overclaimed and pay States identified as having underclaimed. Finally, HEW should provide more assistance to States in carrying out their buy-in programs. HEW agreed with GAO's findings and said the report is a sound interpretation of current policy and problems. Footnotes are included. Appendixes contain States' comments on the report, a letter, and tables of related information. (Author abstract modified)