31 Jan AUDIT REVEALS MILLIONS SPENT ON DUPLICATE MEDICAID ENROLLMENTS
A recent audit by the Washington State Auditor’s Office revealed that Washington state is overspending on Medicaid premiums– an estimated $8.6 million per year– because of beneficiaries being enrolled in Medicaid in multiple states. The audit concentrated on seven states but indicated that the financial impact from duplicate Medicaid enrollments is most likely even higher nationwide.
In 2023, the total Medicaid expenditure across the country reached $880 billion. Among the states with the highest spending on individuals enrolled in Medicaid across multiple states, California topped the list at $134 million, followed by Washington at $65 million.
Duplicate Medicaid payments occur when a person is concurrently enrolled in more than one state Medicaid programs. Duplicate enrollments generally happen when program beneficiaries relocate or do not have stable housing. In Oregon, for example, those with concurrent Medicaid enrollments were found to be two times as likely to be experiencing homelessness compared to the general Medicaid population in Washington.
When recipients are enrolled in more than one state’s Medicaid system, the government improperly pays for their coverage multiple times– without providing any extra benefits. Between 2019 and 2022, Oregon alone spent $445 million on Medicaid payments for duplicate enrollees. A report from Oregon’s state auditors found that somewhere around 3% of Medicaid recipients in the state were also enrolled in another state’s program.
The flawed data tracking system used to discover duplicate enrollments is a major hurdle in correcting this issue. The Social Security Administration’s records are sometimes incorrect, making it very difficult for state agencies to pinpoint individuals enrolled in multiple programs. Attending to this issue requires both internal and external improvements. Internally, Washington’s Auditor’s Office recommends that the Health Care Authority and the Department of Social and Health Services enhance communication to better track people who may have moved out of state. If someone leaves a state-run program due to relocation, that information should be shared across pertinent agencies to prevent continued Medicaid enrollment in Washington. Externally, stronger coordination between states is crucial. Since individuals who enroll in multiple Medicaid programs often relocate to neighboring states, it would be advantageous for state agencies to work together and cross-check enrollment records. Washington and Oregon have arranged a strategy that includes efforts to reclaim funds spent on duplicate enrollments, partnering with the U.S. Treasury to launch a pilot program, implementing national data verification processes, and acquiring funding for additional staff dedicated to data matching.
One of the most useful data-driven solutions for detecting active other coverage in the Medicaid program has emerged from the private sector. Syrtis Solutions (Syrtis) has introduced a technology-based solution to aid the program in identifying third party liability (TPL) before medical and pharmacy claims are paid improperly. With the help of Syrtis Solutions and their proprietary ePrescribing data, Medicaid plans can now identify other coverage on utilizing members in real-time. As a result, plans can avoid duplicate payments and other improper payments.
Medicaid and other taxpayer-funded programs require greater efficiency, quality data, and stringent oversight to protect program resources from duplicate payments and other improper payments. Duplicate Medicaid enrollments drain program resources, and with Washington alone incurring a $8.6 million cost, urgent action is needed to prevent further waste and make certain that program dollars are used to help the nation’s most vulnerable populations.