- Associated Press - Tuesday, December 1, 2015

ALBUQUERQUE, N.M. (AP) - Investigators recommended Tuesday that New Mexico repay the federal government nearly $16 million they say the state should not have received under a health insurance program for low-income children.

The U.S. Health and Human Services’ Office of Inspector General made the recommendation following a review of enrollment over a five-year period beginning in fiscal year 2009.

According to the findings, New Mexico overstated the number of children in the program when compared to enrollment data maintained by the Centers for Medicare and Medicaid Services.

New Mexico received a total of nearly $24 million in bonus payments over five years for enrollments that ranged from more than 305,000 to 332,000 children.

“Most of the bonus payments that New Mexico received for the audit period were not allowable in accordance with federal requirements,” the inspector general stated in the report, noting that only children in specific eligibility categories can be counted.



State officials have argued that their method for determining enrollment was correct and that New Mexico had sought guidance from federal officials as to whether it was in compliance.

State Human Services Department spokesman Kyler Nerison said Tuesday that the agency explained its method and included supporting documentation with each application submitted under the program.

Despite the state’s claims, the inspector general’s office said it was standing by its findings.

It would be up to the Centers for Medicare and Medicaid Services to act on the recommendation.

New Mexico is just the latest state to run afoul of the federal government over bonus payments under the children’s health insurance program. States are eligible for the payments if enrollment increases beyond baseline estimates for a given year.

Audits over the past two years have turned up millions of dollars in unallowable payments in Alabama, Louisiana, North Carolina, Washington and Wisconsin.

The health insurance program is aimed at children in families whose income is too high to qualify for Medicaid but not high enough to afford private or employer-based coverage. Under the program, families pay premiums and share costs but benefits generally are not as comprehensive.

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