California Audit: $4 Billion Paid to Cover Medi-Cal for Ineligible People

Obamacare enrollment (Justin Sullivan / Getty)
Justin Sullivan / Getty
Newport Beach, CA

A California state audit has found the state government paid $4 billion to provide Medi-Cal coverage for almost a half million potentially ineligible people between 2014 and 2017.

California State Auditor Elaine Howle released an audit on October 30 that revealed “pervasive discrepancies between the state and county systems when we compared Medi-Cal beneficiary eligibility data—more than 453,000 beneficiaries were marked as eligible in the State’s system but were not listed as eligible in county systems.”

In addition, the audit found 54,000 people who were marked eligible in the county systems but not the state, which may have delayed access for entitled services.

The audit, prepared for the California legislature, documented that over half the state enrollment “discrepancies” that were not in the county systems had lasted for more than two years. As a result, $3 billion in managed care premiums and $1 billion in fee-for-service claims may have been improperly paid.

To qualify for Medi-Cal under federal rules, a single adult must earn less than $16,754 a year. Although California only has about 12 percent of America’s population, it accounts for 18.5 percent of all Medicaid participants. The latest enrollment figures for the joint federal- and state-funded Medi-Cal program as of May 2018 were 13,171,041, or over 33 percent of the state’s population and about half of its youth.

The California audit follows a February U.S. Health and Human Services Inspector General report that estimated that the state enrolled 366,078 ineligible persons through the Obamacare Medicaid expansion at a cost of $738.2 million. The Inspector General also found that California spent another $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible.

 

The most egregious example cited in the California audit was a resident of Los Angeles County that died in December 2013, yet the state continued to make regular monthly payments to the beneficiary’s Medi-Cal health plan until August of this year. The estimated payments for an individual that the state “should have known was no longer in need of services” amounted to $383,000.

The Democratic candidate for governor, Lt. Gov. Gavin Newsom, backs universal health care for California — though he does not have a plan to pay for it.

Photo: file

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