From 2019 through 2021, the federal Medicaid program paid at least $4.3 billion for patients who were enrolled in two states, The Wall Street Journal reported on March 26. The result was that two states paid the same insurers twice for the same patients’ care, according to an analysis by reporters Christopher Weaver, Anna Wilde Mathews and Tom McGinty.
Those double payments (made on behalf of U.S. taxpayers) went to 270 health insurers for the care of about 660,000 low-income Medicaid patients each year, they wrote.
Often, those patients were enrolled in the Medicaid program in two states simultaneously, frequently because they had moved from one state to another, they added. The patients remained enrolled in the earlier states after enrolling in the new states, they explained.
Most of the patients got their health care through one insurer in one state, even though the federal Medicaid program was paying the insurers in both states, the reporters added. “They aren’t supposed to get paid if a patient leaves for another state,” they wrote. When a Medicaid member moves from one state to another, that member must cancel coverage in the former state, the reporters explained.
“But the recipients don’t always cancel, leaving states to play catch-up,” they added. In their analysis, the reporters identified some Medicaid members who were enrolled in five or more states.
Among the more than 270 Medicaid insurers that collected duplicative payments, the five largest health insurers in the Medicaid program got about one-third of the extra payments, Weaver, Mathews and McGinty explained.
The article showed the five largest Medicaid insurers and the amounts paid over the three years in duplicative payments were:
- Centene, $620 million
- Elevance Health, $346 million
- United Health Group, $298 million
- Molina, $157 million
- Aetna, $143 million
- All other insurers, $2.7 billion.
“Private insurers oversee Medicaid benefits for more than 70% of the about 72 million low-income and disabled people in the Medicaid program,” they explained.
In response to questions from the reporters, the insurers said each state is responsible for verifying each Medicaid member’s eligibility for coverage, the article showed. Also, the insurers said, the three years in the analysis included the 27 months when the Covid-19 public health emergency (PHE) was in effect. In those months, states were prohibited from disenrolling Medicaid members, as we reported in April 2023 and in June last year. The PHE began Jan. 31, 2020, and ended May 11, 2023.
The reporters explained how two states could pay for the same Medicaid member’s enrollment in the same month. Starting in January and continuing through April, Florida would pay a private insurer $291 per month for a total of $1,164. Then, in April if that same member moved to Georgia, the Medicaid program in Georgia would pay a private insurer $339 per month and continue for six months through September for a total of $2,024, the article explained.
If Florida’s payments continued for the five overlapping months (May through September), the Florida Medicaid program payments for those five months would total $1,455. That $1,455 is the total in duplicative payments, meaning waste for the Medicaid program and taxpayers, the reporters wrote.