Governor Nikki Haley has done her fair share of attacking the Affordable Care Act (ACA) and denying South Carolina residents Medicaid expansion. Year after Governor Nikki Haley gutted Medicaid Legislature while a growing need for medicaid expansion increase. On that same note since 2007 Indian Health facilities have deteriorated. Rather pushing the state and Congress to do more for IHS facilities; Governor Haley has instead sued to get rid of the ACA, has refused Medicaid Expansion, and has spent her time in office misappropriating over $59 million to IHS to pay for this growing problem.
The Office of the Inspector General investigated from 2007 to 2014, and found from 2013-2014 that $59,149,483 was incorrectly misappropriated.
Since 1787, under a separate the United States has had an agreement to provide Native/American Indians and Alaska Natives with free health care on reservations.
Just this week on February 4, 2016 Congress held a hearing on deteriorating IHS facilities.
Governor Nikki Haley’s stubborn refusal of ACA and refusing a growing need for Medicaid Expansion hasn’t left South Carolina better off.
Our objective was to determine whether the State agency correctly claimed Medicaid
expenditures on the CMS-64 for IHS facilities at the enhanced FMAP rate from October 1, 2007
through September 30, 2014, in accordance with Federal requirements.
Medicaid Program: How It Is Administered and How States Claim Federal
Reimbursement for Their Expenditures
The Medicaid program provides medical assistance to low-income individuals and individuals
with disabilities and along with the Medicare program represents one of the largest areas of
spending in the Federal Government. In contrast to the Medicare program, both the Federal and
State governments jointly fund and administer the Medicaid program.
At the Federal level, the Centers for Medicare & Medicaid Services (CMS), an agency with the
Department of Health and Human Services (DHHS), administers the Medicaid program. Each
State administers its Medicaid program in accordance with a CMS-approved State plan. In
South Carolina, the South Carolina Department of Health and Human Services (State agency)
administers the Medicaid program. The State plan establishes which services the Medicaid
program will cover. Although the State has considerable flexibility in designing and operating
its Medicaid program, it must comply with applicable Federal requirements.
The Federal Government pays its share of a State’s medical assistance expenditures under
Medicaid based on the FMAP, which varies depending on the State’s relative per capita income.
Although FMAPs are adjusted annually for economic changes in the States, Congress may
increase FMAPs at any time. Certain Medicaid services receive a higher FMAP, including
family planning services (90 percent) and services provided through an IHS facility (100
percent). CMS’s State Medicaid Manual instructs States to use Column (c) of the base Form
to report expenditures provided by IHS facilities.
Enhanced Federal Reimbursement of Certain Primary Care Service Expenditures
The Patient Protection and Affordable Care Act (ACA)3
established an enhanced Medicaid
FMAP reimbursement rate of 100 percent for primary care services provided in 2013 and 2014
by a physician with a primary specialty designation of family medicine, general internal
medicine, or pediatric medicine.
The State agency did not always claim the correct Medicaid amount as IHS expenditures from
October 1, 2007 through September 30, 2014, in accordance with Federal requirements. The
State agency correctly claimed IHS expenditures of $115,735, but incorrectly claimed ACA
enhanced physician payment expenditures of $59,149,483 in Column (c) of the CMS-64.9.
EXPENDITURES INCORRECTLY CLAIMED AS INDIAN HEALTH SERVICES
CMS’s State Medicaid Manual instructs States to use Column (c) of the CMS-64.9 to report
expenditures provided by IHS facilities. The State agency incorrectly claimed $59,149,483 of
ACA Medicaid expenditures in Column (c), IHS facilities, on the CMS-64.9. Specifically:
For the quarter ending September 30, 2013, the State agency incorrectly claimed ACA
expenditures of $24,475,037 as IHS expenditures on the CMS-64.
For the quarter ending December 31, 2013, the State agency incorrectly claimed ACA
expenditures of $10,486,948 as IHS expenditures on the CMS-64.
For the quarter ending March 31, 2014, the State agency incorrectly claimed ACA
expenditures of $9,781,311 as IHS expenditures on the CMS-64.
For the quarter ending September 30, 2014, the State agency incorrectly claimed ACA
expenditures of $14,406,187 as IHS expenditures on the CMS-64.
We recommend that the State agency work with CMS to establish review procedures to ensure
that Medicaid expenditures are claimed in the correct column of the CMS-64.