OIG inspection detects vulnerability in eligibility data

Do Texas Medicaid recipients who move out of state still receive benefits? The OIG conducted an inspection to determine if Health and Human Services Commission (HHS) Access and Eligibility Services (AES) ensures proper eligibility determinations for clients.

Medicaid clients who move out of Texas risk losing benefits if they fail to report the move or fail to declare their intent to return to Texas. AES identifies out-of-state clients using client notifications, out-of-state spending reports, case information, returned mail or automated data exchanges. Texas Medicaid is at risk of making monthly capitation payments to managed care organizations for ineligible clients if clients who live outside the state are not identified in a timely manner.

The inspection concluded AES ensures proper eligibility determinations, but it also found a vulnerability in the information the Texas Integrated Eligibility Redesign System receives from the Social Security Administration.

Read the full report.