GAO finds errors in coverage, payments for Medicaid beneficiaries under ACA

October 21, 2015

Federal investigators from the GAO said they discovered many errors in eligibility decisions under the ACA. The investigators said some people were getting subsidies for private insurance at the same time they were enrolled in Medicaid. In other cases, the investigators said, the government cannot always distinguish between newly eligible beneficiaries and those eligible under the old rules. The federal government is paying 100% of the cost of Medicaid for newly eligible people, but for others it should pay a much smaller share, averaging 57% of the costs. The discrepancy is potentially significant, the investigators said, because the federal government expects to spend more than $400 billion on newly eligible Medicaid beneficiaries from 2014 to 2023. Moreover, the auditors said, CMS which runs the federal marketplace, “does not have procedures to automatically terminate subsidized exchange coverage when individuals are determined eligible for Medicaid.” The Obama administration said it was stepping up efforts to “prevent duplicate coverage.” In addition, the administration said it provided “significant training and guidance” to make sure states correctly identify new Medicaid beneficiaries for whom the federal government should pay the entire cost. The administration previously said it started a data-matching program to help ensure Medicaid beneficiaries would not receive subsidies through the marketplace. The accountability office said this was not enough to minimize the potential for duplicate coverage.
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Obamacare still exposed to fraud, double-dipping with Medicaid: GAO - The Washington Times
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