31 Jan MILLIONS SPENT ON DUPLICATE MEDICAID ENROLLMENTS
A recent audit by the Washington State Auditor’s Office revealed that Washington state is overspending on Medicaid premiums—an estimated $8.6 million annually—due to individuals being enrolled in Medicaid programs in multiple states. The audit focused on seven states but suggested that the financial impact from duplicate Medicaid enrollments is likely even higher nationwide.
In 2023, the total Medicaid expenditure across the U.S. reached $880 billion. Among the states with the highest spending on individuals enrolled in Medicaid across multiple states, California topped the list at $134 million, followed by Washington at $65 million.
Duplicate Medicaid payments occur when an individual is simultaneously enrolled in multiple state Medicaid programs. Duplicate enrollments typically happen when program beneficiaries relocate or lack stable housing. In Oregon, for instance, those with concurrent Medicaid enrollments were found to be twice as likely to be experiencing homelessness compared to the general Medicaid population in Washington.
When beneficiaries are enrolled in more than one state’s Medicaid system, the government improperly pays for their coverage multiple times—without providing any extra benefits. Between 2019 and 2022, Oregon alone spent $445 million on Medicaid payments for duplicate enrollees. A report from Oregon’s state auditors found that approximately 3% of Medicaid recipients in the state were also registered in another state’s program.
The flawed data tracking system used to identify duplicate enrollments is a significant hurdle in resolving this issue. The Social Security Administration’s records are sometimes inaccurate, making it difficult for state agencies to pinpoint individuals enrolled in multiple programs. Addressing this issue requires both internal and external improvements. Internally, Washington’s Auditor’s Office recommends that the Health Care Authority and the Department of Social and Health Services enhance communication to better track individuals who may have moved out of state. If someone leaves a state-run program due to relocation, that information should be shared across relevant agencies to prevent continued Medicaid enrollment in Washington. Externally, stronger coordination between states is essential. Since individuals who enroll in multiple Medicaid programs often move to neighboring states, it would be beneficial for state agencies to collaborate and cross-check enrollment records. Washington and Oregon have agreed on a strategy that includes efforts to reclaim funds spent on duplicate enrollments, partnering with the U.S. Treasury to launch a pilot program, implementing national data verification processes, and securing funding for additional staff dedicated to data matching.
One of the most effective data-driven solutions for identifying active other coverage has emerged from the private sector. Syrtis Solutions (Syrtis) has introduced a technology-based solution to aid the program in identifying third party liability (TPL) before medical and pharmacy claims are paid improperly. With the help of Syrtis Solutions and their proprietary ePrescribing data, Medicaid plans can now identify other coverage on utilizing members in real-time. As a result, plans can avoid duplicate payments and other improper payments.
Medicaid and other taxpayer-funded programs require greater efficiency, quality data, and stringent oversight to protect program resources from duplicate payments and other improper payments. Duplicate Medicaid enrollments drain program resources, and with Washington alone incurring a $8.6 million cost, urgent action is needed to prevent further waste and ensure that program dollars are used to help the nation’s most vulnerable populations.