Taxpayers Spent Billions Covering the Same Medicaid Patients Twice

When recipients signed up in two states at once, insurers often got paid by both; ‘it definitely is wasteful’

By Christopher Weaver, Anna Wilde Mathews and Tom McGinty of The WSJ. Excerpts:

"Health insurers got double-paid by the Medicaid system for the coverage of hundreds of thousands of patients across the country, costing taxpayers billions of dollars in extra payments.

The insurers, which are paid by state and federal governments to cover low-income Medicaid recipients, collected at least $4.3 billion over three years for patients who were enrolled—and paid for—in other states"

"The biggest Medicaid insurer, Centene, received $620 million in duplicative payments between 2019 and 2021"

"Insurers said it is up to states to verify people’s eligibility, and to disenroll them if necessary."

"The Medicare and Medicaid agency doesn’t screen for the double payments, leaving that to the states. State officials said identifying people who moved is difficult, and that recoveries of improper payments from managed-care companies are limited."

"The federal government’s emergency pandemic rules made it much harder for states to disenroll beneficiaries."

"double payments nationwide increased from $814 million in 2019 to $2.1 billion in 2021."

"When an enrollee leaves one state and signs up in a different one, though, the first state isn’t automatically informed." 

"it is difficult for states to claw back payments from managed-care companies for covering relocated enrollees, largely because it can be unclear exactly when they left."

"taxpayers were wasting about $1 billion a year"

"it can be difficult to verify where people are living" [this reminds me of Hayek saying that the central planners don't have local knowledge so they can't run the economy very well]