Medicaid Fraudulent Enrollment


ObamaCare expanded eligibility for Medicaid – but not for everybody!

We have already discussed the unintended expansion of Medicaid to people who already had private health insurance (Medicaid Expansion Woes). This unintended consequence of ObamaCare is costing states billions of taxpayer dollars. In Louisiana alone it is estimated this practice will cost taxpayers between $900 million and $1.3 billion over five years.

But now we learn there is rampant fraudulent enrollment in Medicaid. A study published by the National Bureau of Economic Research finds that in several Medicaid-expansion states most people who gained coverage have enrolled in Medicaid regardless of their income. ObamaCare has become a new entitlement for the middle class that was never intended.

Brian Blase and Aaron Yelowitz, writing in The Wall Street Journal, say the authors of that study used data from U.S. Census Bureau’s American Community Survey to assess coverage changes from 2012- 2017 in nine states that expanded Medicaid vs. 12 states that did not. Their results identified a huge problem.

In 2017 alone, in those nine states, “around 800,000 individuals . . . appeared to gain Medicaid coverage for which they were seemingly income-ineligible.”

For review, Medicaid eligibility was expanded by ObamaCare to households with incomes below 138% of the federal poverty line (FPL), or nearly $36,000 for a family of four in those states that accepted the expansion. In the nine states studied, Arkansas, Kentucky, Michigan, Nevada, New Hampshire, New Mexico, North Dakota, Ohio and West Virginia, the authors found that among households with incomes 138% to 250% of FPL (about $65,000 for a family of four), some 78% that gained coverage were improperly enrolled in Medicaid. That was also true of 65% of the population above 250% of FPL that gained coverage.

What’s more, the problem is getting worse with time. It was found to be two to three times more prevalent in 2017 than in 2014, the first year the plan was implemented. When you recognize that people tend to minimize rather than maximize income information, the amount of fraud identified here is staggering. Furthermore, the nine states in the study represent only about 20% of the total population living in Medicaid expansion states.

Blase and Yelowitz say, “ObamaCare has turned out to be a giant welfare program, with millions of working and middle-class Americans improperly receiving Medicaid – a reflection of the unpopularity of the exchange policies and incompetence of government oversight.”

Those states that opted out of the Medicaid expansion program under ObamaCare have fared much better in preserving their private insurance coverage. Employer-sponsored coverage has steadily grown in these states with virtually no growth in expansion states.

It is no surprise that millions are gaming the system for their own benefit. What is surprising, and unacceptable, is the level of incompetence, perhaps even malfeasance, in government workers responsible for proper enrollment of new Medicaid patients. Medicaid needs to be protected and taxpayer dollars preserved for the disabled and low-income children, pregnant women and seniors, for which it was originally intended.

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