31 Jan MILLIONS LOST DUE TO DUPLICATE MEDICAID ENROLLMENTS
A recent audit by the Washington State Auditor’s Office uncovered that Washington state is overspending on Medicaid premiums– an estimated $8.6 million each year– as a result of plan members being enrolled in Medicaid in multiple states. The review concentrated on seven states but suggested that the financial impact from duplicate Medicaid enrollments is likely even higher nationwide.
In 2023, the total Medicaid expenditure across the United States 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 simultaneously enrolled in more than one state Medicaid program. Duplicate enrollments normally occur when program beneficiaries relocate or do not have stable housing. In Oregon, for example, those with simultaneous 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 roughly 3% of Medicaid recipients in the state were also registered in another state’s program.
The problematic data tracking system used to recognize duplicate enrollments is a considerable hurdle in correcting this issue. The Social Security Administration’s records are often inaccurate, making it difficult for state agencies to pinpoint individuals enrolled in multiple programs. Resolving this issue requires both internal and external improvements. Internally, Washington’s Auditor’s Office suggests that the Health Care Authority and the Department of Social and Health Services improve communication to better track individuals who may have moved out of state. If someone leaves a state-run program because of relocation, that information should be shared across relevant agencies to stop continued Medicaid enrollment in Washington. Externally, stronger coordination between states is necessary. Since individuals who enroll in multiple Medicaid programs often move to neighboring states, it would be advantageous for state agencies to collaborate and cross-check enrollment records. Washington and Oregon have agreed on a strategy that includes efforts to reclaim funds spent on duplicate enrollments, partnering with the U.S. Treasury to release a pilot program, implementing national data verification methods, and acquiring funding for additional staff dedicated to data matching.
One of the most helpful data-driven solutions for determining active other coverage in the Medicaid program has emerged from the private sector. Syrtis Solutions (Syrtis) has launched a technology-based solution to aid the program in identifying third party liability (TPL) before medical and Rx 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 strict 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.