New York's Medicaid program paid $388M for federally-funded services, audit shows

New York's Medicaid program paid $388 million for medical services between 2016 and 2022 that should have been paid by federally-funded plans such as Medicare, according to two audits from the state's comptroller published Sept. 14.

The first audit covered July 2016 to June 2021. It found the state's Medicaid program could have saved up to $294.4 million in medical payments if 13,318 enrollees, who appeared to be Medicare-eligible, had been enrolled in the program over the six period. 

Under the ACA, New York offers a health plan to low-income individuals that are not eligible for Medicaid, called the Essential Plan. Qualifications for Medicaid and the Essential Plan are similar, so enrollees can transition from one to the other as certain factors change.

The second audit covered Jan. 2017 to Nov. 2022. The Essential Plan was not viewed by the state as a primary insurer during overlap periods, resulting in Medicaid paying the full amount for services during overlaps — totaling $93.7 million.

"Far too often the Department of Health has let the state's Medicaid program pay for services that federally-funded health care programs should have covered," State Comptroller Thomas DiNapoli said. "As the DOH continues its efforts to ensure everyone gets the health coverage they're entitled to, it has a chance to save hundreds of millions of dollars by improving its oversight."

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