nc-stampSB 546 – Accuracy/Medicaid Eligibility Determinations
Primary Sponsors: Sen. Ralph Hise (R – Madison), Sen. Brent Jackson (R – Duplin), Sen. Tommy Tucker (R – Union)
This bill would support improvements in the accuracy of Medicaid eligibility determination.
Starting on January 1, 2019, the NC Department of Health and Human Services, Division of Central Management and Support would audit all county social services departments to ensure compliance with accuracy standards.
Audits would be conducted for initial Medicaid eligibility determination applications as well as Medicaid re-enrollment determinations.
The Department would require the social services departments to comply with the following accuracy standards:

  • With regards to errors causing an ineligible Medicaid recipient to be approved for Medicaid benefits;
  • With regards to errors causing the denial of benefits to an applicant who should have been approved;
  • With regards to errors made during the eligibility determination process that did not change the outcome of the eligibility determination.

The bill also states that a county Department of Social Services would be financially responsible for erroneous issuance of Medicaid benefits and Medicaid claims payments resulting when the county Department of Social Services takes action that requires payment.