Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Springfield Enrollment Center

This is a state audit report about how MassHealth’s Springfield enrollment center checked income eligibility for people applying in person.

“In this audit, we reviewed the asset/income-related eligibility verification activities that MassHealth conducted at its Springfield enrollment center for the period January 1, 2017 through December 31, 2018.”

The State Auditor’s office reviewed this because it has a Medicaid Audit Unit meant to help catch fraud, waste, and abuse in MassHealth.

“The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program.”

MassHealth is a very large public program, serving about 1.9 million people and making up a major share of the state budget, so accurate eligibility decisions matter.

“Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.”

If you rely on MassHealth, apply for it, or help pay for it as a taxpayer, this report says the Springfield office’s income checks generally worked as expected during the audit period.

“Did the Springfield enrollment center verify the income of MassHealth walk-in applicants and revoke benefits from MassHealth members who were found not to be eligible according to Section 502.003 of Title 130 of the Code of Massachusetts Regulations?”

The auditor concluded that the Springfield enrollment center did verify income and revoke benefits when people were found ineligible based on the rules reviewed.

“Our audit revealed no significant instances of noncompliance that must be reported under generally accepted government auditing standards.”

The report does not list corrective actions or recommendations because it did not identify significant reportable problems.

“This report details the audit objective, scope, and methodology for the audit period, January 1, 2017 through December 31, 2018.”

The audit provides independent oversight of a major health program and found only one sampled case where someone eligible was put in the wrong benefit plan, not enough to become a formal finding.

“From the sample of 176 applicants tested, we noted one exception.”

“Income eligibility” means MassHealth compares a household’s income with federal poverty level limits to decide whether someone qualifies for coverage.

“Applicants must meet certain income requirements to qualify for MassHealth coverage.”