A Resolution directing the Legislative Budget and Finance Committee to conduct an audit of the medical assistance programs of the Commonwealth and provide a report to the General Assembly.

PRINTER'S NO. 1416
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE RESOLUTION
No. 216
Session of
2026
INTRODUCED BY DUSH AND MARTIN, JANUARY 30, 2026
REFERRED TO HEALTH AND HUMAN SERVICES, JANUARY 30, 2026
A RESOLUTION
Directing the Legislative Budget and Finance Committee to
conduct an audit of the medical assistance programs of the
Commonwealth and provide a report to the General Assembly.
WHEREAS, Medical assistance is a crucial State service that
helps vulnerable populations obtain and maintain health care
coverage, and mismanagement, inefficiency or defraudation of the
Commonwealth's medical assistance program could threaten the
health coverage of the vulnerable populations that the medical
assistance program serves; and
WHEREAS, Medical assistance funding comprised 30% of all
General Fund spending in the 2024-2025 fiscal year; and
WHEREAS, Data from the Independent Fiscal Office shows that
the total funding for Medicaid rose from approximately $30
billion in the 2018-2019 fiscal year to nearly $50 billion in
the 2024-2025 fiscal year; and
WHEREAS, The United States Office of Inspector General
published the Review of Pennsylvania Medicaid Managed Care
Program Potential Savings With Minimum Medical Loss Ratio in
July 2017, which found that the Commonwealth could have saved
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millions of dollars if the State would have required managed
care organizations to meet a minimum Medical Loss Ratio Standard
and required remittances if the standard was not met; and
WHEREAS, The United States Office of Inspector General
published an audit report in 2024 that found that Pennsylvania
improperly claimed $551 million in Medicaid funds for its
school-based program; and
WHEREAS, Investigators have identified a large amount of
Medicaid fraud in Minnesota and many individuals have been
charged for fraud in Minnesota, demonstrating that State
Medicaid programs could be vulnerable to exploitation; and
WHEREAS, Based on the audit published in 2017, the audit
published in 2024 and the events that are unfolding nationally,
Pennsylvania should perform an audit to ensure that our medical
assistance programs are operating efficiently and safe from
fraud; and
WHEREAS, Ensuring the efficiency and security of our State's
medical assistance programs will ensure that our medical
assistance program can be funded and vulnerable populations
continue to receive coverage without interruption; therefore be
it
RESOLVED, That the Senate direct the Legislative Budget and
Finance Committee to conduct an audit and issue a report on the
State's medical assistance programs; and be it further
RESOLVED, That the Legislative Budget and Finance Committee
be authorized to request from Commonwealth agencies and
departments any data or information that is necessary to conduct
the study; and be it further
RESOLVED, That the report include all of the following:
(1) The actuarial standards used in Pennsylvania to
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evaluate Medicaid managed care program contracts, including
the actuarial soundness of the contract and medical loss
ratio standards, and how those standards compare with the
standards used federally and in other states.
(2) Whether the Commonwealth has adopted the
recommendations of the audit published by the United States
Office of Inspector General in 2017 and, if not, the amount
that could have been saved since 2017 if the recommendations
were adopted.
(3) Whether the Commonwealth has adopted the
recommendations of the 2024 audit.
(4) An analysis of high-risk programs and contracts to
search for any indicators or evidence which would indicate
widespread fraud within the system.
(5) Any information the Legislative Budget and Finance
Committee deems relevant;
and be it further
RESOLVED, That the report include any recommendations for
further studies or audits; and be it further
RESOLVED, That the Legislative Budget and Finance Committee
submit a report with its findings and recommendations to the
General Assembly within 18 months of the adoption of this
resolution.
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