Editor’s Note: Although this commentary deals with Iowa law, it also concerns the national issue of Medicaid.
Medicaid enrollment surged from 23 million to 95 million during the COVID-19 pandemic as eligibility requirements were eased and states were given financial incentives to expand their Medicaid enrollment slots . In fact, during the pandemic, states couldn’t kick anyone out of Medicaid unless they died or quit.
By early 2023, more than 95 million Americans will be enrolled in Medicaid. According to Centers for Medicare and Medicaid Services (CMS) data, $80.6 billion will be spent fraudulently in 2022, and a whopping $98 billion in 2021. Most of these improper payments (66%) triggered red flags due to eligibility issues.
Before the pandemic disrupted the healthcare system, Medicaid was supposed to work as a program to provide healthcare to people who couldn’t work or couldn’t afford it. But during the pandemic, Medicaid became the default health care option for millions of Americans.
To provide care to those who really need it and keep premiums more affordable for businesses and families who pay for private health insurance, states need to stop paying people who aren’t eligible for Medicaid.
Nearly one in four Americans now receives Medicaid health care, but Medicaid was originally created to care for the poor and disabled. We are preparing to eliminate those who do not.
Iowa’s Senate Bill 494 does just that by updating the state’s eligibility determination process. Beginning in 2026, it is estimated that 8,000 Medicaid enrollees will become ineligible in Hawkeye State because they are ineligible for Medicaid benefits.
Senate Bill 494 aims to reform Medicaid eligibility requirements. Nearly 900,000 Iowans are enrolled in Medicaid and related government-run health care plans. But Iowa reports only 287 improper payments. That tiny number is just the tip of the iceberg, with most of the wasted money going to insurance companies to pay for Medicaid coverage for those who don’t qualify.
Determining eligibility involves confirming who the person is and having a clear picture of their financial needs. For homeless people and those who don’t regularly bank, this is so taxing that the state may simply decide it’s too difficult and focus on other areas of program integrity. I have. SF 494 Section 3 requires that before HHS grants public assistance benefits to an applicant, the applicant uses a variety of available methods to verify the applicant’s identity through knowledge-based questionnaires such as: You must complete a computerized identity verification process. Financial and Personal Questions… Tailored to help those who are unbanked or have difficulty accessing financial or banking services. “
Medicaid fraud can be minimized by using private actors. This makes sense. Managed care providers should embrace this concept and integrate it as part of their responsibilities. States must find ways to meaningfully communicate with Medicaid enrollees to improve overall care and determine eligibility for scarce resources.
As unemployment rises, so will the size and cost of Medicaid currently being built. If Iowa really wants to reform its Medicaid problem, it will need to take drastic action to ensure that every Medicaid beneficiary truly needs a support program.
Unless Iowa and several other states take the necessary steps to curb corruption and prevent people from taking advantage of the expansion of Medicaid, the problem will only get worse.
Now that the pandemic is officially over, it is also time to put an end to the expansion and exploitation of government-run health care programs.
Also, it is plainly unfair for Iowans who do not have Medicaid to bear the costs of those who choose not to work and therefore cannot pay for their own medical services.
Matt Dean ([email protected]) is a Senior Fellow in Health Policy at the Heartland Institute. This commentary was provided to News-Press by The Center Square, a non-profit organization dedicated to journalism.
