Overview
- Optum will analyze Medicaid claims for irregularities, flagging issues for DHS to review and refer to the state Office of Inspector General when improper billing is suspected.
- Payments for the targeted services are paused for up to 90 days, and the state says it will still meet federal timelines for provider reimbursements.
- The high-risk services include Housing Stabilization Services, Early Intensive Developmental and Behavioral Intervention for autism, Integrated Community Supports, Nonemergency Medical Transportation, and Personal Care Assistance/CFSS.
- Officials say abuse of waiver-based Medicaid programs may total hundreds of millions of dollars, with active investigations and recent charges tied to housing and autism-related schemes.
- Provider groups warn the payment pause could destabilize care networks, while political leaders disagree over whether the step represents decisive action or delayed oversight.