Washington State Fails To Verify Eligibility of Some Medicaid Beneficiaries, Licenses of 25% of Providers, Audit Says

Washington state has not verified the eligibility of about half of its Medicaid beneficiaries or the license records for about 25% of the providers who care for them, according to a draft report from the state auditor, the Seattle Post-Intelligencer reports. The annual review, part of a larger audit of how the state uses federal funds, found that Washington state is not adhering to federal Medicaid guidelines. Such noncompliance could "jeopardiz[e] funding," State Auditor Brian Sonntag said. The auditor's report examined 60 families with children who were enrolled in Medicaid, finding that 27 had annual incomes that made them ineligible for coverage. The Auditor's Office said this sample is "representative of a substantially bigger problem." The audit also found that the state Department of Social and Health Services does not conduct a sufficient number of eligibility checks for Medicaid beneficiaries and did not require proof of income in checks that were completed. "This is a very substantial amount of public funds. It's a very significant report, and it's one that the state has to respond to," Sonntag said, adding, "If this doesn't get cleaned up, then I think it puts the future of these kinds of federal funds at potential risk." DSHS has said that the auditor's report "overstated" the problem and action is being taken to improve eligibility monitoring.

Provider Licensing Concerns
The audit also examined the state's use of federal funds to reimburse Medicaid providers, finding that 29 out of 121 health professionals had "deficient license records." Of the 29 providers with deficient records, the audit found that 13 did not have a license, 11 had licenses that had expired and five were listed under "erroneous names." Despite the licensing problems, the 29 providers received $10 million in federal funds during fiscal year 2001. In response, DSHS officials said they plan to randomly check licenses on a quarterly basis and will require providers to notify the agency of any changes to their licenses (Galloway, Seattle Post-Intelligencer, 3/13).