Medicaid and Children’s Health Insurance Program (CHIP) Client Eligibility Determinations - 391-0710-19

Description of Agency

The Michigan Department of Health and Human Services (MDHHS) establishes client eligibility for individuals in need of Medicaid and Children’s Health Insurance Program (CHIP) health care services. Oversight of the eligibility determination process is primarily performed by the Economic Stability Administration (ESA) within MDHHS. The 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 and $258.2 million in direct beneficiary level payments were issued on behalf of 3.3 million and 478,000 individuals enrolled in the Medicaid and CHIP programs, respectively.

Audit Objectives

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

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

Timing

Estimated Release Date: Early 2021


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