The U.S. Government Accountability Office has found that 13% of Medicaid beneficiaries also had private health insurance for at least part of the year that they were covered by Medicaid, according to the Census Bureau’s annual population survey covering 2002-04. The private insurance was typically obtained through employment. Of the 39 states that responded to GAO’s request for information, 27 of them said they had difficulties verifying whether Medicaid beneficiaries had other health coverage, and 35 said they were unsuccessful collecting payment from third-party insurers after Medicaid paid claims.
Provisions in the Deficit Reduction Act of 2005 require states to have laws in effect that could help address some of these problems. The GAO recommends that the Centers for Medicare and Medicaid Services provide guidance to states in regard to time frames for enacting laws in accordance with those DRA requirements as well as which entities are required to provide states with healthcare coverage data. CMS concurred with the GAO’s recommendations. Read the GAO report.
