After discovering that millions of people are wrongly collecting federally backed health care benefits, the Health and Human Services Department told federal investigators that it is taking steps to eliminate dual enrollment.
HHS said it looked at enrollees in Medicaid and the Children’s Health Insurance Program and matched them against those collecting Obamacare’s Advance Premium Tax Credit.
The department said it will soon provide states with a one-time list of dual-enrollees and prod states to re-check eligibility.
Investigators said their review this summer found 2.8 million people in 2024 who were either claiming Medicaid or CHIP benefits across multiple states, or were enrolled in both programs and the Obamacare credit — even though the taxpayer-funded benefits are supposed to be mutually exclusive.
In 2024, about 1.2 million Americans were enrolled in Medicaid or CHIP in two or more states each month, while about 1.6 million were enrolled in both programs and the Obamacare credit.
HHS said it is working with states to eliminate and prevent inappropriate duplicate enrollment, and reminded states on Nov. 6 of their obligation to do so.
“Based on the results of this analysis, HHS will take action to ensure individuals are only enrolled in one program and to stop the federal government from paying multiple times for these individuals to receive health coverage,” Gary Andres, HHS’s assistant secretary for legislation, told the Government Accountability Office in a report released this week.
He was responding to GAO’s review of enrollees in six states, which found 500,000 double-enrollees in 2023, totaling at least $1.6 billion in potential payments.
HHS said eliminating the 2.8 million duplicates it found could save about $14 billion annually.
GAO studied California, Georgia, New York, Pennsylvania, Tennessee and Texas, as opposed to the HHS report that looked at all states.
Investigators found about 149,000 people enrolled in Medicaid or CHIP in multiple states for at least three months during fiscal year 2023. They allowed a three-month buffer to account for people who moved states and needed time to transfer their benefits.
The audit also identified about 340,000 people who were enrolled in Medicaid or CHIP and also collected the advance premium tax credit.
And another 18,000 people collected the tax credit in more than one state.
GAO pointed to one case where someone was enrolled in one state and received a $771-a-month credit the whole year; was enrolled in a second state for six of those months, getting $848 a month in the tax credit; and was enrolled in a third state for five more months, at $1,100 per month.
The report said the number of duplicates is relatively small compared to overall enrollment and spending — Medicaid alone had 32.6 million beneficiaries across the six states — but the programs must have more timely controls to identify and prevent duplication.
“Even limited instances of duplicate enrollment can result in significant costs and signal potential vulnerabilities in program oversight,” GAO said.
Investigators suggested that COVID-19 may have been responsible for some of the duplication. Under pandemic-era rules, states were limited in their ability to kick people off their programs.
“This period was problematic for us,” Stephanie Shell, deputy secretary at Pennsylvania’s Department of Human Services, told GAO in an official response to the report.
She said from April 2023 to March 2024, the state was “unwinding” from the pandemic restrictions on cleaning up its rolls, even as the federal government told it to continue providing benefits in most cases to individuals who had enrolled across states.
It is unclear how significant a problem the pandemic was for HHS’s review in 2024.
GAO recommended that HHS improve its methods for spotting duplicate enrollees, such as requiring the use of interstate data matching.
• Mary McCue Bell can be reached at mbell@washingtontimes.com.
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