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

This is a state audit of how MassHealth checked income eligibility at its Taunton enrollment center from January 1, 2017 through December 31, 2018.

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

The State Auditor has a Medicaid Audit Unit meant to help catch or prevent 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 major public program serving many Massachusetts residents and using a large share of the state budget.

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

If you use or pay taxes toward MassHealth, this audit looked at whether people were being checked properly before getting benefits.

“To assist individuals who want to apply for MassHealth benefits for the first time or renew their existing benefits, MassHealth operates four enrollment centers, located in Tewksbury, Chelsea, Taunton, and Springfield.”

The audit answered yes: the Taunton center verified income and revoked benefits when members were found ineligible.

“Did the Taunton 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 report does not list corrective actions, because the audit did not find significant reportable noncompliance.

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

The audit gives the public some assurance that, for the sample reviewed, the Taunton center’s income checks were working as required.

“We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.”

“Eligibility verification” means checking whether applicants meet rules such as income, residency, citizenship, and immigration status before MassHealth decides what benefits they can receive.

“Employees at these enrollment centers are responsible for collecting all of the necessary information and documentation from each applicant and verifying, as required, that each applicant meets all of the program’s eligibility requirements related to assets, income, residency, and citizenship.”