Abstract: The WSJ is extremely concerned about Medicaid double dipping because of potential fraud and potential impact on estimates of the uninsured. Analysis presented here suggests double dipping need not lead to fraud because most Medicaid expenditures are related to actual delivery of services and there are severe restrictions on Medicaid payments to out-of-state providers.
A recent WSJ opinion cited a CMS study, which found that 1,2 million people were enrolled in subsidized health care programs in two or more states and 1.6 million people were enrolled in both Medicaid and an Obama Care state exchange health insurance plans. The WSJ article believes that enrollees in two are more subsidized health programs are costing the government money and are resulting in an overestimate of the number of people who will lose their health care due to the recently enacted tax bill.
I share the WSJ’s curiosity and concern about potential ramifications of recipients receiving more than one health care subsidy and their desire for additional research.
Medicaid subsidies are primarily but not exclusively in the form of payments for services, not payments for premiums. Whan a person moves from state A to state B, either temporarily or permanently, services and subsidies should stop in state A and could begin in state B. There is no double dipping when people move to a new state enroll in a new Medicaid or state exchange health insurance program and then claim benefits exclusively in the new program.
Many people especially at the lower end of the income spectrum have more than one health care plan during a year. People who change from one plan to another are not double dippers if they are not claiming benefits simultaneously from both plans.
Some or much of the documented number of households with more than one subsidy per year may represent legal and natural use of multiple programs because of changes in income and eligibility status.
Many people must move from one state to another state during the year. Consider a person residing in North Carolina who has relatives in New York and finds day care or a job in New York for part of the year. It would be natural for a person temporarily residing in a second state to apply for coverage when outside their home state, especially for a prolonged visit.
The enrollment in multiple Medicaid programs may be unavoidable for some people residing in multiple states during a year because many state Medicaid programs do not provide benefits to out-of-state providers. According to CHAT GPT Florida, Michigan, New York and Texas have Very Restrictive out-of- state coverage while Colorado and Oklahoma have notable restrictions.
Often hospitals automatically enroll patients for Medicaid who receive services. The existence of a person enrolled in more than one program, when a person is temporarily residing in a second state, may stem from the actual delivery of health care services to a person who is otherwise uninsured or insured in a state that does not provide benefits to out-of-state providers. The double enrollment may stem from actions taken by providers not the recipient of the service.
I share the WSJ concern about households having to use multiple health insurance plans during a year, a practice that is clearly less than ideal. Ways to decrease enrollment in multiple Medicaid and state exchange health insurance programs involve making sure that the state exchange health insurance premium remains affordable the entire year, keeping people on Medicaid for an entire year even if their eligibility status changes, and making sure people who travel across state lines can pay out-of-state providers for delivered services.
Authors Note: A previous article examined implications of loss of health insurance during job transitions and during recessions also supports the need for policies that help maintain continuous health insurance coverage. Go here for abstracts on several other health care memos recently published at Economic and Political Insights.