Evidence record
Examining Washington’s Concurrent Medicaid Enrollments
- Jurisdiction
- Washington
- Publishing agency
- Office of the Washington State Auditor
- Publication date
- October 28, 2024
- Source record
- Original document linked
Findings
5
Recommendations
5
Overall conclusion
The audit highlights significant financial waste due to concurrent Medicaid enrollments, emphasizing the need for improved communication, data sharing, and federal solutions to prevent unnecessary premium payments and optimize Medicaid spending.
Scope
The audit examined Washington’s Medicaid program, focusing on concurrent enrollments from 2019 to 2022, analyzing data from HHS-OIG, and reviewing processes involving Washington’s Health Care Authority and Department of Social and Health Services, as well as collaboration with other states including Oregon.
Findings (5)
Each finding has a stable link.
- F-164
Washington unnecessarily paid an average of $8.6 million annually in premiums for long-term concurrent enrollees in seven states.
- F-165
Over $135 million was spent nationwide on unneeded premiums during the last year of the public health emergency.
- F-166
More than 131,000 people were concurrently enrolled in Medicaid in Washington and at least one other state during 2019-2022.
- F-167
Concurrent enrollment results in duplicate payments, with states paying for benefits only received once by the client.
- F-168
Federal and state agencies' current systems and policies are insufficient for early detection and resolution of concurrent enrollments.
Recommendations (5)
- R-193
Implement federal solutions for early identification of concurrent enrollments.
Related finding F-168 - R-189
Improve inter-agency communication and automated notification systems between HCA and DSHS.
Related finding F-168 - R-190
Update and amend MCO contracts to enable better recovery of unnecessary premiums.
Related finding F-164 - R-191
Enhance federal data sharing and reporting mechanisms to identify concurrent enrollees more promptly.
Related finding F-168 - R-192
Strengthen verification processes to confirm client residency and eligibility across states.
Related finding F-166