The findings of a recent audit performed by the Washington State Auditor’s Office showed that on average, Washington paid $8.6 million on unnecessary Medicaid premiums for clients residing in the seven states being reviewed, with even more costs across the nation. Auditors also found that Washington could improve existing processes to reduce unnecessary premium payments, but Medicaid needs better solutions nationwide.
Nationwide, state governments spent $880 billion on Medicaid in 2023. Washington spent $29.2 billion, Idaho spent $3.6 billion, Wyoming spent $726 million, and Montana spent $2.4 billion in the same time frame. The states that spent the most on concurrent Medicaid recipients are California with $134 million and Washington state with $65 million.
The Washington state report found that one of the biggest problems is concurrent Medicaid enrollments. This happens when one person is enrolled in multiple states. This is due to individuals moving, or not having permanent housing. In Oregon for example, individuals who had concurrent enrollments were twice as likely to be homeless than the rest of the Medicaid population in Washington.
This results in the government paying multiple times for the same person and not providing any additional benefits. In the report, Washington officials noted that they have worked to increase communication with Oregon to resolve these cases. Between 2019 and 2022, Oregon spent $445 million in covering duplicate Medicaid enrollees.
Oregon state auditors commented that “about 3% of Oregon’s Medicaid recipients were also enrolled in another state.”
One of the major difficulties with addressing this issue is the inaccuracy and discrepancies found in the system used to track the enrollees. The Social Security Administration can provide faulty information that throws off those looking for concurrent enrollments. While this ultimately does fall on the state governments, the federal government has to upgrade and improve its tracking systems to provide more real-time data to state agencies.
There seem to be two sides to addressing this issue on the state level. One is internal and the other is external. On the internal side, The Washington State Auditor suggested that the Health Care Authority and Department of Social and Health Services increase their communication to identify individuals who have potentially moved. If an individual leaves one government program due to relocating to a different state, that information needs to be communicated throughout the state departments to prevent concurrent enrollments.
On the external side, increased communication between neighboring states is critical. Most of the time these individuals move to a neighboring state and the governments can simply check to make sure there aren’t any duplicates in programs spanning over multiple states like Medicaid.
Washington state and Oregon concluded that the best course of action is to create a process to recover the funds spent on duplicate enrollments, work with the U.S. Treasury to create a pilot project, create a process to check national data, and request funds for additional data matching staff. This looks to be the best course of action. Taxpayer-funded programs like Medicaid need a high level of accountability to be efficient.
One concurrent Medicaid enrollment is one too many, and with a single state paying $8.6 million, it demonstrates this issue needs to be addressed immediately.
Sam Cardwell is a Policy Analyst for the Mountain States Policy Center, an independent research organization based in Idaho, Montana, Eastern Washington and Wyoming. Online at mountainstatespolicy.org.
