Innovative Washington, Oregon audits explore double Medicaid enrollment across state lines

Medicaid provides needed health care for more than one in four people in Washington, at a cost of about $19.6 billion a year. However, Washington also pays millions of dollars for Medicaid coverage of people already insured by other states, according to a new performance audit by the Office of the Washington State Auditor.

When someone moves out of state without closing their Medicaid coverage, then signs up for the program in their new state, two states pay for two policies when only one is needed to ensure that person’s medical care. Known as concurrent enrollment, it costs the former state money that could be spent on other benefits. The U.S. Department of Health and Human Services, Office of Inspector General, is working to reduce concurrent enrollment nationwide.

The audit conducted by the State Auditor’s Office examined seven states with the highest concurrent enrollment. Auditors worked in tandem with their counterparts in the Oregon Secretary of State Audits Division to understand how the movement of Medicaid clients between the neighboring states affects enrollment.

“This collaborative approach offers both Washington and Oregon an opportunity to ensure people receive the care they need, while preventing unnecessary costs to our health care systems,” said State Auditor Pat McCarthy. “Together with the insightful work of our colleagues in the Oregon Audits Division, we have made an especially valuable contribution to our federal partner’s understanding of how and why concurrent enrollment happens.”

The Oregon Secretary of State Audits Division also released a performance audit of concurrent enrollment today. While other states have partnered with the Office of Inspector General to analyze Medicaid enrollment, this is the only time two states have partnered to do a deeper dive on Medicaid data around concurrent enrollment.

“The results of this audit analysis are enormously beneficial. Reducing concurrent enrollment does not eliminate anyone’s Medicaid benefits, it simply eliminates a wasteful duplicate payment,” said Oregon Secretary of State LaVonne Griffin-Valade. “I want to thank our partners in the Washington State Auditor’s Office, and the Health and Human Services Office of Inspector General, for their assistance with this unique and innovative audit work. Both Oregonians and Washingtonians benefit from this kind of collaboration.”

After reviewing a sample of concurrent enrollment cases in Oregon and six other states, Washington auditors concluded the state paid about $8.6 million a year on unnecessary Medicaid premiums for longer term concurrent enrollees in those states.

Washington’s report found inaccurate data from the Social Security Administration to be one of several factors leading to concurrent enrollment. Coverage along the Columbia River dividing Washington and Oregon is especially complex, auditors found, as some concurrent enrollees regularly visited providers in both states, making it hard to tell which state should pay for their coverage.

Across states, concurrent enrollees in the audit’s sample population were twice as likely to be homeless as the general Medicaid managed care population, and many concurrent enrollments reflected the complex circumstances of the people involved.

While Medicaid needs better nationwide solutions to prevent and manage concurrent enrollment, Washington’s agencies could improve existing processes to reduce unnecessary premium payments.

The full Washington report, including recommendations to the two Washington agencies responsible for Medicaid and their responses the audit’s findings, can be found here: Examining Washington's Concurrent Medicaid Enrollments

Oregon’s performance audit of concurrent enrollment can be found here: Without Federal Action, States Will Continue to Pay Millions of Dollars in Duplicate Medicaid Payments

Media questions: Assistant Director of Communications Adam Wilson, Adam.Wilson@sao.wa.gov, 564-999-0799