Medicaid Managed Care Capitation Payments on Behalf of Incarcerated Enrollees

States contract with Medicaid managed care organizations to provide specific services to Medicaid enrollees, usually in return for a predetermined periodic payment known as a capitation payment. Section 1905 of Title XIX of the Social Security Act, 42 CFR § 435.1009, and guidance from CMS state that Federal financial participation is generally not available for services provided to adult inmates of public institutions except when the individual is not in a prison setting and becomes an inpatient in a medical institution. We will determine whether select States made unallowable capitation payments to Medicaid managed care organizations on behalf of individuals incarcerated in State prisons.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
July 2024	Centers for Medicare and Medicaid Services	Medicaid Managed Care Capitation Payments on Behalf of Incarcerated Enrollees	Office of Audit Services	WA-24-0057 (W-00-24-31581)	2026