Medicaid Client Eligibility Determination - 391-0710-19

Description of Agency

The Michigan Department of Health and Human Services (MDHHS) establishes client eligibility for individuals in need of Medicaid health care services. Oversight of the eligibility determination process is primarily performed by the Economic Stability Administration (ESA) within MDHHS. ESA provides guidance in process, policy, training, technology, and leadership to the MDHHS local offices, and MDHHS local office caseworkers determine eligibility. During fiscal year 2019, $14.7 billion in direct beneficiary level payments were issued on behalf of 3.3 million individuals enrolled in the Medicaid Program.

Audit Objectives

  1. To assess the effectiveness of MDHHS’s efforts to complete accurate Medicaid eligibility determinations.

  2. To assess the effectiveness of MDHHS’s oversight of the Medicaid client eligibility determination process at MDHHS local offices.

Timing

Estimated Release Date: Late 2020


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