EXCLUSIVE: The top Republican on the Senate Budget Committee is demanding answers from both the Newsom and Biden administrations regarding promised repayment of $52 million in “improperly claimed” Medicaid disbursements made via “MediCal” to certain immigrants.
Sen. Charles Grassley of Iowa sent letters to both California Gov. Gavin Newsom and Centers for Medicare & Medicaid Services (CMS) administrator Chiquita Brooks-LaSure, requesting updates on the Golden State’s promise to return to the feds $52 million in wrongful disbursements from payouts to “noncitizens with unsatisfactory immigration status[es].”
In response to a previous Fox News Digital inquiry on the matter, a representative for the California Department of Health Care Services (DHCS) acknowledged the findings of an inspector general’s report on the matter and pledged to repay the feds by June 30.
CALIFORNIA AGREES TO REPAY FEDS $52M IN IMPROPERLY-CLAIMED IMMIGRANT MEDICAID DISBURSEMENTS
California Gov. Gavin Newsom, left, and Sen. Charles Grassley, R-Iowa. (Getty Images)
“The investigation found that the state over-counted its reimbursable emergency care percentage by 8.49 percent, and had improperly claimed $52,652,698 from the start of October 2018 to the end of June 2019,” Grassley wrote to Newsom regarding Health and Human Services (HHS) Inspector General Christi Grimm’s probe.
“HHS OIG recommended that California refund the $52.7 million improperly claimed during that period and work with CMS to find any additional improperly claimed reimbursements for periods outside of the OIG audit.”
Grassley added that it appears California did not adjust its algorithm for determining Medicaid disbursements to such immigrants, after the inspector general’s report made the recommendation.
“As of today, [they] remain unimplemented. Each state must ensure that proper care is taken to protect the American taxpayer from fraud, waste, and abuse,” Grassley wrote.
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Grassley followed up with a list of questions he wanted Newsom to answer by Sept. 5.
“Has California repaid any portion of the money it improperly received from the federal Medicaid program? If so, how much and when? If not, why not?” he wrote.
“What is California’s current methodology to quantify its portion of reimbursable income?”
Grassley also noted California’s annual budget is around $300 billion, therefore, questioning why the California DHCS is using a “manual process” to repay the feds rather than an immediate lump sum.
The May audit conducted by Grimm underlined that federal Medicaid benefits are usually limited only to citizens and “qualified” noncitizens. Examples of qualified noncitizens are refugees, people granted asylum or those lawfully admitted for permanent residence.
The audit covered more than $372 million in federal Medicaid reimbursements made on behalf of noncitizens during FY 2019.
The report, in part, blamed outdated algorithmic metrics on California’s end for the discrepancy in “improperly claimed” Medicaid reimbursements for the particular noncitizen class.
In comments to Fox News Digital, Grassley said economic conditions created by President Biden and Vice President Kamala Harris have led to households now “struggling, and having to stretch their dollars in every which way.”
“Meanwhile, California is providing federal health insurance to ineligible illegal immigrants using taxpayers’ hard-earned money,” he added.
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The Centers for Medicare & Medicaid Services logo is seen displayed on a smartphone. (Getty Images)
“It’s a slap in the face, and we ought to know what CMS is doing to collect the improper reimbursements California confirmed it owed months ago.”
In his corresponding letter to Brooks-LaSure, Grassley noted the Social Security Act of 1935 requires the feds to reimburse states via her agency for a percentage of their Medicaid costs.
He said that, for “noncitizens with unsatisfactory immigration status,” only “emergency services” are typically covered after five years of coverage.
MediCal (the state’s equivalent to Medicaid) “uses state funds to provide full coverage for noncitizens with UIS by paying each managed care plan a monthly capitation,” Grassley said.
He similarly asked Brooks-LaSure whether California repaid their liability, and whether her agency has initiated any type of review to prevent this from happening in the future.
Meanwhile, illegal immigrants remain ineligible overall for federal coverage and disbursements under the Affordable Care Act, according to HealthCare.gov.
Fox News Digital reached out to CMS for an independent update on California’s agreed-upon repayment of the Medicaid remittances.
In a statement at the time, an official with California’s DHCS expressed plans to repay the requested amount by June 30.
“Additionally, DHCS has worked with the federal Centers for Medicare & Medicaid Services to develop and implement a more refined service identification methodology with updated payment and claiming processes,” the spokesperson said.
UPDATE: A spokesperson for the federal Center for Medicare & Medicaid Service said California has since returned the $52 million cited in the inspector general’s report.
