Republicans want to curb the number of ineligible people on Medicaid, but Democrats worry that more red tape will make it harder for people to get the coverage they qualify for.
The Republican-led Senate Finance Committee’s healthcare subcommittee, citing several federal reports, is looking into improper Medicaid payments to states that are enrolling people in the program who aren’t eligible.
Federal and state spending on Medicaid reached $629 billion in fiscal year 2018. About $36 billion—or roughly 10% of federal Medicaid spending—shouldn’t have been authorized, according to the U.S. Government Accountability Office.
Gaps in oversight, poor data quality and a lack of federal-state cooperation are significant contributors to the high rate of improper Medicaid payments. The large size and immense complexity of the program make it vulnerable to enrollment problems, especially because Medicaid gives states a great deal of flexibility in terms of how they run it, the GAO said.
“The controls are not in place to tell (people enrolled in Medicaid) that they did things appropriately,” said Brian P. Ritchie, Assistant Inspector General for Audit Services at HHS’ Office of Inspector General. “There’s no paper (or) audit trail to show that things were done properly.”
But several subcommittee Democrats and witnesses thought that concerns over illegibility were overblown because many people who receive benefits are, in fact, eligible for the program even though they don’t fill out the paperwork. They said that states are denying benefits to people who qualify for Medicaid but can’t figure out how to prove that they’re eligible because the reporting requirements are too complicated.
“Can’t we figure out a simpler way so that people who are eligible can get into these programs?” Sen. Benjamin Cardin (D-Md.) said.
Sen. Sherrod Brown (D-Ohio) added that Republicans who reject “big government … should understand that making individual peoples’ lives … harder means a lot of them don’t apply for (Medicaid).”
Conservatives have been concerned for years that a lack of effective oversight would cause excessive waste, fraud and abuse within the Medicaid program.
“This is a government program. You have to have rules,” said Daryl Purpera, Louisiana’s legislative auditor.
Republicans also expressed concern on Wednesday that the expansion of Medicaid under the Affordable Care Act might have exacerbated existing problems by increasing the size of the program. They said that the system can’t adequately deliver benefits to qualified beneficiaries when its financial resources are spent on people who are ineligible for Medicaid.
But the subcommittee’s Democrats wanted to know why so many Republicans were supportive of lawsuits to get rid of the Affordable Care Act if they were concerned about a loss of coverage.
The 5th U.S. Circuit Court of Appeals could decide to uphold a lower court ruling that would invalidate Obamacare entirely. An analysis by the liberal Urban Institute estimates that about 20 million people will lose coverage if the courts throw out the ACA altogether.
Democrats worry that efforts to impose stricter compliance measures for Medicaid could decrease enrollment further, which could ultimately hurt children.
Nearly 2 million more people lacked health insurance in 2018 compared with the year before, according to a report from the U.S. Census Bureau. The report showed that a dropoff in Medicaid coverage caused most of the decline. And the number of children without health insurance coverage grew in 2018, according to a new report by Georgetown University’s Center for Children and Families.