New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option

Why OIG Did This Audit

In October 2015, the Centers for Medicare & Medicaid Services (CMS) approved New York's Community First Choice option (CFCO). The approval allowed New York to receive an additional 6 percent of Federal Medical Assistance Percentage (FMAP), referred to as "enhanced FMAP," for eligible home and community-based services and supports provided to individuals that would otherwise require an institutional level of care.

Our objective was to determine whether New York followed its CMS-approved methodology for claiming enhanced FMAP on payments made for CFCO services.

How OIG Did This Audit

Our audit covered $310 million in fee-for-service payments and $4.5 billion in managed care payments for beneficiaries determined eligible by New York. New York claimed enhanced FMAP of $287.6 million related to these payments on its Form CMS-64s for CY 2016. We reviewed New York's CFCO eligibility determinations for 60 beneficiaries for whom New York claimed the enhanced FMAP.

What OIG Found

New York followed its CMS-approved methodology for claiming enhanced FMAP on Medicaid fee-for-service and managed care payments made for CFCO services provided to beneficiaries that New York determined eligible in CY 2016.

What OIG Recommends

This report contains no recommendations.