Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS)

New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees (OAS-25-02-074)

This audit found that the New York State Department of Health (state agency) made unallowable managed care capitation payments on behalf of incarcerated Medicaid enrollees during our audit period, January 2021 through December 2024.  These payments totaled $7,551,670 ($6,164,734 federal share) for all 1,375 enrollees in our review.  We determined that the state agency did not always disenroll individuals from Medicaid managed care after receiving notification that they were incarcerated.

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