Louisiana's Department of Health may have spent up to $85.5 million on Medicaid recipients who are ineligible for the program, an audit report released Tuesday shows.
Health department Secretary Rebekah Gee said her agency has new technology in place effective Tuesday that will "increase the accuracy of eligibility decisions" in the future.
Legislative Auditor Daryl Purpera's report said his auditors used Louisiana Workforce Commission data to evaluate a sample of Medicaid recipients from the Medicaid expansion population.
"We found that LDH’s current process of using wage data at application and renewal to determine the eligibility of the Medicaid expansion population is not sufficient," his report said.
Auditors determined, based on the sample taken, that the state may have spent between $61.6 million and $85.5 million for Medicaid recipients who didn't qualify at some point during their Medicaid coverage.
The report said at least 20 other states indicated on their verification plans that they check for changes in recipient wages on an interim basis.
During the period sampled the agency relied too much of self-reporting from the recipients, the report said.
Gee said the agency's new automated system will be able to access Louisiana Workforce Commission data as well as other wage data to make eligibility decisions.
“The department’s process for determining Medicaid eligibility has been a very manual and time consuming process based on income information provided by applicants,” Gee said in a press release. “Effective today, the department has launched a new automated system for Medicaid eligibility and enrollment that will improve customer service, boost efficiency and increase the accuracy of eligibility decisions.”
Gee said the new Medicaid eligibility and enrollment system uses advanced technology to ensure benefits go only to those who meet eligibility and program requirements.
"The system will connect with state and federal databases to provide more data for real-time verification of citizenship, income, disability and lawful presence in the United States," the agency said in a press release. "In addition, it enables consistent enforcement of policy, with timely, automated coverage terminations for non-compliance."
The agency said ineligible recipients identified in the audit will be issued "closure notices" and asked to provide proof of their current income.
If they don't respond or if their reported income is above the eligibility limit their Medicaid coverage will be terminated.
The agency also said if it determines the ineligible recipients intentionally committed fraud then officials will report them to law enforcement agencies and the state will seek to recover previous Medicaid payment made.
Greg Hilburn covers state politics for the USA TODAY Network of Louisiana. Follow him on Twitter @GregHilburn1
