A recent audit of Guam’s Medicaid program identified $400.7 million in benefits provided to more than 35,000 clients during fiscal years 2023 and 2024, but found widespread administrative deficiencies, including missing applications, incomplete documentation, delayed renewals, and inconsistent notifications of eligibility decisions.
The Office of Public Accountability reviewed 30 client files and noted that some lacked initial or renewal application forms, Eligibility Specialist review, and client signatures. Other files showed late or missing submission of required documents, change reports, and off-island referral forms. In some cases, clients received Medicaid benefits without proper notification of eligibility decisions.
The audit, part two of a three-part series on the Department of Public Health and Social Services (DPHSS) Medicaid program, concluded that while deficiencies were significant, there were no questioned costs for benefits already availed. The report emphasizes the need for consistent compliance with federal and local Medicaid rules to maintain program integrity and public trust.
The OPA issued seven recommendations to DPHSS management to improve documentation, timely review of applications, client notifications, and monitoring of eligibility requirements. Officials acknowledged DPHSS staff efforts to enroll eligible residents and stressed the importance of improvements to inspire public confidence.