Audit Recommends Improvements to
Medical Assistance Oversight
MADISON – Today, the nonpartisan Legislative Audit Bureau (LAB) released its evaluation of the Medical Assistance program, which is administered by the Department of Health Services (DHS). The Medical Assistance program funds health care for individuals with low and moderate incomes, including the elderly, individuals with disabilities, children and their parents, and childless adults.
“This audit comes out at a very crucial time considering the financial condition of our state,” said Sen. Cowles (R-Allouez). Roughly 20% of Wisconsin citizens are enrolled in Medical Assistance and now is a great time to make sure that only those who need the benefits and qualify receive them.”
Total Medical Assistance expenditures increased from $5.0 billion in fiscal year (FY) 2006-07 to $7.5 billion in FY 2010-11. This was largely due to an increase in the number of recipients, which grew from 870,000 in January 2007 to 1.2 million in January 2011.
In an effort to make the program more cost effective and ensure that only those who qualify for benefits receive them, fraud prevention activities are taken up by both state and local agencies. Fraud prevention financial recoveries totaled $2.9 million in FY 2006-07 through FY 2010-11. It was also found that during this time period, 6.5% of the 1,354,700 individuals who enrolled in the program had previously resided in
another state or country. Furthermore, 21% of those receiving benefits received them within their first month of residence.
LAB was able to make several recommendations to make the program more cost effective. DHS should assess all costs before entering into contracts with vendors and assess the benefits of enrolling recipients in managed care plans more quickly. Finally, LAB noted that DHS does not include all costs related to Medical Assistance in the program’s budget nor record them as the program’s expenditures. Additionally,
DHS does not account for expenditures by the different Medical Assistance subprograms—such as BadgerCare Plus—which is how policymakers and the public consider the program.
“The comprehensive information this audit provides will be vital as we move forward,” said Rep. Kerkman (R-Randall). “Improving our Medical Assistance program should assure that only eligible Wisconsinites receive benefits from our state’s generous program and that spending can be as transparent as possible.”
To obtain a copy of report 11-15, please visit the LAB’s Web site at http://legis.wisconsin.gov/lab/ or call 608-266-2818.