A new audit says Louisiana’s health department may have paid as much as $85 million over 20 months for Medicaid enrollees who didn’t qualify for coverage.
Legislative Auditor Daryl Purpera’s office released the audit. Auditors found problems with the department’s use of wage data to determine eligibility for people enrolled in Louisiana’s Medicaid expansion program.
The report says the department relies on Medicaid recipients to self-report changes in their paychecks in the 12-month period between application for Medicaid and renewal of coverage. Auditors suggested more frequent checks of available state wage data.
The health department says it follows a federally-approved verification plan for double-checking Medicaid recipients’ income. But Health Secretary Rebekah Gee also says the agency is launching a new automated system to improve eligibility reviews.
Purpera’s office used a random sample of 100 Medicaid recipients in the expansion program, to check if their income exceeded the threshold for eligibility. Auditors found 82 didn’t qualify for 47% of the monthly payments the health department made to Medicaid managed-care companies for their health care coverage from July 1, 2016, through March 31, 2018.
The monthly fee paid per ineligible recipient averaged $3,824, the report says. Projecting those results across the entire Medicaid expansion population, auditors wrote, suggests the health department spent anywhere between $61.6 million and $85.5 million on people who weren’t eligible for Medicaid coverage.