Auditor: Lax system let ineligible people get public health care aid

Updated 12:40 p.m.

Minnesota human services officials didn't verify that low income people enrolling in health plans through MNsure were eligible for benefits they got, the state legislative auditor said Wednesday.

Related: A clue to MNsure's problems discovered in HealthMatch

The state Department of Human Services did not check key eligibility criteria, such as Social Security numbers, citizenship, income, and household sizes for Medical Assistance (Minnesota's Medicaid program), MinnesotaCare, and Children's Health Insurance Program recipients.

That screening breakdown "resulted in ineligible persons receiving public health care benefits," the auditor said in its report.

"They're not getting it right," Legislative Auditor Jim Nobles said.

"We design these systems to make complex eligibility determinations. We spend a lot of money, taking quite a bit of time now, and we ought to be at a point when they can get it right all the time, in every case," he added.

The programs provide low-cost or free health coverage to low-income residents. But the department did not ensure that data "accurately and securely transferred from MNsure into the state's medical payment system."

The audit also found "many instances" where department officials "did not comply with the federal and state legal requirements related to recipients' eligibility for Medical Assistance, MinnesotaCare, and the Children's Health Insurance Program."

And it scolded the department for charging incorrect MinnesotaCare premium rates.

Other findings:

• The Department of Human Services unnecessarily paid for $44,993 of health care benefits because 24 people who enrolled through MNsure had duplicate accounts in the state's health care programs.

• Nearly 17 percent of the people in records sampled by the auditor were not eligible for the public health care program in which they were enrolled.

• The Department of Human Services did not provide county human service eligibility workers with sufficient training on MNsure.

• Eligibility workers were unable to close cases when recipients had income and family relationship changes that made them ineligible for benefits or when recipients asked workers to close their cases.

Human Services Commissioner Lucinda Jesson said the problems occurred during the early implementation of MNsure and the department has been working to correct them.

The next MNsure sign-up period begins Saturday.

This is the second report connected to the legislative auditor's review of MNsure operations.

Two weeks ago, the auditor's office wrote that MNsure, the state's online health insurance marketplace launched last year, lacked adequate control over its big marketing budget and hasn't always complied with rules laid out by state and federal officials, or its own board.