State Auditor: MassHealth Needs Better Checks On Income, Residency

Mass. state auditor Suzanne Bump

WBUR’s news staff reports on findings released today by state auditor Suzanne Bump. She found shortcomings in the state’s $12-billion MassHealth program, the government insurance for lower-income residents:

State auditor Suzanne Bump is auditing the MassHealth program, saying it lacks safety measures to verify applicants’ income, or that they live in Massachusetts.

The audit says MassHealth, which provides care to low-income residents, cost the state $6.5 million in 2010 alone by treating patients who may have lived outside Massachusetts. It also does not verify an applicant’s supplemental income, such as lottery winnings.

And State House News reports:

Income verification shortcomings in the state’s massive MassHealth program make it possible for ineligible applicants to receive health insurance benefits for a year before being removed from the program, according to an audit released Wednesday.

According to Auditor Suzanne Bump, MassHealth’s first verification of an applicant’s self-reported earned income occurs a year after applicants are enrolled and receiving benefits.  Bump also reported that MassHealth does not verify information about unearned income of applicants, or resources derived from lottery winnings, for instance, or stock dividends, pension payments or rental income.  While Bump did not conclude that the procedures are leading to benefits being awarded to ineligible individuals, she said her audit results show the need for improvements in the verification process and may be costing the state millions of dollars a year.

At a cost of about $12 billion per year, about a third of the state budget, MassHealth provides health insurance coverage and access to services for about 1.3 million low and moderate-income individuals in Massachusetts.   Bump also concluded “thousands” of individuals who are not residents of Massachusetts may be receiving MassHealth benefits inappropriately because MassHealth does not have a process to effectively verify the state residency of applicants and only verifies residency in cases where conflicts are found in applications.

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