A recent analysis has uncovered that Medicaid, the joint federal and state health insurance program for low-income individuals, misspent at least $4.3 billion over a three-year period by covering the same patients twice.
From 2019 to 2021, Medicaid made duplicate payments for approximately 660,000 beneficiaries annually. These individuals were enrolled in Medicaid programs in multiple states, often after relocating without canceling their previous enrollment. As a result, Medicaid paid private insurance companies in both states to cover the same individuals, even though they were receiving services in only one state.
The three largest Medicaid insurers benefited significantly from these overpayments:
- Centene Corporation: Received $620 million in duplicate payments.
- Elevance Health: Collected $346 million.
- UnitedHealth Group: Obtained $298 million.
These figures highlight systemic inefficiencies within Medicaid’s enrollment and eligibility verification processes.
The COVID-19 pandemic exacerbated the issue. Emergency rules implemented during this period limited states’ ability to disenroll ineligible beneficiaries, causing duplicative payments to more than double from $800 million in 2019 to $2.1 billion in 2021.
Insurers argue that verifying eligibility and disenrolling beneficiaries are the states’ responsibilities. However, critics contend that both insurers and state agencies must improve coordination to prevent such wasteful spending. The federal agency overseeing Medicaid has committed to collaborating with states to address and rectify these inefficiencies.
