Bill > SCR46

This joint resolution requests the State Auditor to conduct biennial management and financial audits of Hawaii's Medicaid health care insurance contractors, with the first audit to be completed within six months of July 1, 2025. The resolution stems from concerns about oversight of managed care organizations (MCOs) contracted by the Department of Human Services, highlighting issues identified in a 2023 Centers for Medicare and Medicaid Services (CMS) program integrity review, which found problems with fraud prevention, payment accuracy, and inter-agency coordination. The proposed audits would assess the financial integrity, performance, and legal compliance of Medicaid health care insurance contractors, with contractors required to cooperate by providing necessary documents and records. The Auditor is requested to submit findings and recommendations to the Governor, Legislature, and Director of Human Services prior to the 2027 Regular Session, with the option to conduct additional audits as needed. The resolution defines Medicaid health care insurance contractors as managed care organizations under contract with the Department of Human Services, and aims to promote transparency, ensure appropriate fund usage, verify quality of care for Medicaid beneficiaries, and improve the overall effectiveness of the state's Medicaid Managed Care Program.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SCR&billnumber=46&year=2025