A new audit from the Utah State Auditor’s Office revealed significant issues with the state’s Skilled Nursing Facility Upper Payment Limit Medicaid program. The audit revealed that, of the state’s $1 billion budget, only 49% of the money intended for patient care was used by nursing facilities between 2016 and 2024.
The remaining 51% of the funds were kept by non-state government entities as administrative fees, according to a press release from the office.
The investigation uncovered that from 2016 through 2024, the three largest non-state government entities were in charge of distributing over $922 million in program payouts. However, it was discovered that only around $450 million of that was actually handed out to facilities. The remaining money, around $472 million, was kept by the hospital groups rather than then distributed.
The audit was conducted after the office received a request to investigate the possibility of misused Medicaid funds in Utah. Auditors from the state conducted interviews with the state Department of Health and Human Services employees, reviewed both state and federal Medicare guidance and traced the flow of funding from the money given to them by the non-state government entities to the final payments the nursing facilities received.
“It is deeply concerning that over half of the funds intended to support Medicaid patients in skilled nursing facilities didn’t reach the intended recipients,” said State Auditor Tina M. Cannon.
“These are not just numbers on a spreadsheet, this is about ensuring that this type of Medicaid funding is used for its intended purpose — to provide direct care and improve the quality of life for patients in nursing facilities. We urge the Department of Health and Human Services to implement our recommendations to ensure these funds are accounted for appropriately and transparently and are used as intended: for the benefit of nursing facility residents.”
Author: Andrew Streeter
Photo courtesy of the National Institutes of Health
Editor: Hannah Clove
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