Louisiana Medicaid Audit Results Mischaracterized

Some lawmakers and press accounts are mischaracterizing a 2018 audit of Louisiana’s Medicaid program, saying it shows that most Medicaid recipients enrolled under the state’s Medicaid expansion are ineligible. Senator Ron Johnson and Rep. Jim Jordan suggested, based on the audit, that 93 percent of the state’s Medicaid expansion population is ineligible. But that seriously mischaracterizes the audit findings, which show a much less dramatic problem. Moreover, the state is addressing the problem with its new eligibility system, which went live in November, and is now reviewing the eligibility of beneficiaries whose income may have risen since they enrolled.

The audit focused on a specific group of beneficiaries: single-person households enrolled through the state’s Medicaid expansion (under the Affordable Care Act) whose earnings, as reported in the state’s quarterly wage database, suggested that their incomes may have risen above the Medicaid eligibility threshold after they enrolled. That group represents a little less than 10 percent of single-person households enrolled through the expansion.

• The auditors first examined the 100 cases in this group with the highest incomes and found that 93 of them had income above the Medicaid threshold at some point after enrolling.
• The auditors then took a random sample of 100 cases in the same group already identified as potentially having increased income and found that 82 of them were above the eligibility threshold at some point while receiving Medicaid.

So the share of beneficiaries who were potentially ineligible represents 8 to 9 percent of single-person households in the expansion population (that is, 82 to 93 percent of 100 cases, which in turn was just under 10 percent of all single-person households in the expansion), not 82 to 93 percent of the expansion population — much less of the entire Medicaid population.

Some have implied that these cases show fraud. In fact, the vast majority of these people were eligible when they first enrolled in Medicaid — the state verified their eligibility using electronic data sources, including information on citizenship and income — but their income later changed, which is not uncommon among low-income people. Most beneficiaries must renew their eligibility every 12 months. Between renewals, they must report income changes that make them no longer eligible; also, many states check data sources during this period, flag households with income that may make them ineligible, and request information from them to verify that they’re still eligible.

Medicaid has made major progress in streamlining and modernizing eligibility determinations in recent years, including increasing the use of electronic data sources to verify eligibility. These improvements have reduced burdens on working families and agency staff, while maintaining program integrity. States can — and should — continue improving their eligibility systems and processes (as Louisiana is doing). But no one should misconstrue or misrepresent findings like these and then use them to reimpose burdensome processes that inhibit access to health care coverage for eligible low-income people.