Medicaid managed care insurers received at least $4.3 billion in duplicate payments for beneficiaries enrolled in multiple states between 2019 and 2021, The Wall Street Journal reported March 26.
In many cases, Medicaid beneficiaries move to another state, but do not disenroll from Medicaid coverage in their former state. Both states then pay Medicaid plans for the individual’s coverage, but the enrollee is only drawing benefits in one state, according to the Journal.
Five things to know:
- Centene, the largest Medicaid managed care insurer, received $620 million in duplicate payments between 2019 and 2021, according to the Journal‘s analysis. Elevance Health received $346 million, and UnitedHealth Group received $298 million.
- Rules in place during the COVID-19 pandemic made it difficult for states to disenroll beneficiaries from Medicaid. Duplicative payments more than doubled during this time, according to the Journal, rising from $800 million in 2019 to $2.1 billion in 2021.
- In some cases, the same insurer covered the same individual in more than one state, the Journal found. On average, Centene insured around 25,000 people in multiple states at the same time.
- A spokesperson for Centene told the Journal it repaid states around $2 billion between 2019 and 2021. The Journal’s analysis “ignores the financial safeguards in place to address potential overpayments,” the spokesperson said.
- A spokesperson for CMS told the Journal the agency duplicate payments are a “prime example of taxpayer dollars being mismanaged” and the agency is committed to working with states to solve the issue.
Read more here.
