According to a state audit released this past week, California’s Medicaid program, Medi-Cal, spent $4 billion between 2014 and 2017 on coverage for beneficiaries that may have been ineligible for Medicaid.
California’s $100B Medicaid program covers 13.1 million residents of the state (one-third of the state) and eligibility is determined by county workers. Lately the records have not been adding up with over 450,000 individuals deemed ineligible by their respective counties but not by the state. The disparity between records could be a result of a beneficiary receiving a raise and no longer meeting the minimum required for Medicaid coverage, moving away, or passing away.
More than half of the discrepancies discovered by the audit lasted for over two years, but questionable payments were not the only issue. State auditors identified over 50,000 California residents were eligible to receive Medicaid coverage but were not recorded as eligible in the state’s system.
In a letter addressed to the Gov. of California, state auditor Elaine Howle wrote:
“Because health care providers use Health Care Services’ records to authorize care for beneficiaries, eligible individuals may encounter hardship when their eligibility status is not accurately reflected in Health Care Services’ records.”
As a recommendation, the audit advised that the department recover the payments in question by June and have a better system in place by the end of the year. A response from the Department of Health Care Services accepted the recommendations but contested the timeline.
Read more about the Medicaid discrepancies from the LA Times.
Or view the full audit here.