Taxpayers have effectively been paying twice for the same people enrolled in government-driven health insurance. The Centers for Medicare & Medicaid Services (CMS) announced on Thursday that they identified 2.8 million people enrolled in two or more taxpayer-subsidized plans, across Medicaid and Affordable Care Act plans. That’s a problem Congress was targeting with the reforms to Medicaid it just passed.
Over the past six years, the Medicaid program has grown faster than the population, the economy, and even inflation, increasing the burden on taxpayers at an alarming rate. Growth during the pandemic surged, but Medicaid never fell back to its pre-pandemic scale due to the Biden administration’s relaxation of enrollment standards.
Back in 2022, the Department of Health and Human Services (HHS) reported that there were more than 300,000 multi-state beneficiaries as of 2020. Double enrollment likely grew after that, considering enrollment grew 34 percent between 2020 and 2023. The state of Washington conducted its own analysis and found that more than 131,000 people enrolled in Medicaid in Washington were also enrolled in other states at some point between 2019 and 2022.
HHS promptly recommended that the Centers for Medicare and Medicaid Services (CMS), the federal agency tasked with managing Medicaid, dedicate additional funding to state monitoring. But back then, CMS rejected this idea, arguing additional monitoring would be “redundant, inefficient, and confusing to States,” according to HHS. Instead, CMS proposed rules to make enrollment and re-enrollment easier, including preventing states from reviewing eligibility more than once a year.
Fast forward to now, and one big aim of the “One Big Beautiful Bill” (OBBB) has been to restore some semblance of responsibility and scrutiny back to the program, starting with the implementation of work requirements. Apart from the more obvious goals of work requirements, this provision would also make it more difficult for states and insurance plans to collect Medicaid payments for ineligible or non-existent beneficiaries.
CMS, now under the leadership of Dr. Oz, hopes to identify and root out concurrent enrollments.
The Congressional Budget Office (CBO) projected an outcome of 11.8 million more uninsured people by 2034 and reduced spending by about $1 trillion. Not quite. Some reduced spending would surely come from the elimination of ineligible or concurrently enrolled beneficiaries – people who would still retain insurance under one program or the other.
By removing the concurrent enrollments, CMS could reduce federal spending by $168 billion between 2025-2034. A prospective $168 billion in savings is a sizeable piece of the $1 trillion reduction in Medicaid spending. Additionally, of the 11.8 million additional uninsured CBO projects for 2034, up to 2.8 million, or nearly 25 percent, could just be left-over enrollments from people who have moved to a different state.
These are essential elements of the projections that have received inadequate attention despite the abundant media coverage of the bill.
Furthermore, concurrent enrollment is just one source of improper enrollment. There could also conceivably be people who take up jobs with higher pay (thus no longer qualify) or people with insurance included in new employment, not to mention people in multiple states that even this audit didn’t catch. Yet these phony enrollees are also included in and inflate the CBO’s numbers.
Lastly, based on the CBO’s estimates, several researchers have suggested that because many people are losing their coverage, beneficiaries’ health and lives will be put at risk. That can’t be true for people who remain insured in the state they reside in and only lose their duplicate enrollment in an out-of-state plan.
The enormous complexity of the government-run health care system makes it hard for the average citizen to understand. But in this case, we know the problem: double enrollment. At long last, CMS will take steps to solve this problem.
