Insurers Make Billions off Medicaid (Medi-Cal) In California During Obamacare Expansion

Medi-Cal is California’s Medicaid program.

More than 1 in 3 Californians, or 13.5 million people, are covered by Medicaid — more than the population of Pennsylvania. About 80% of those in California’s program are enrolled in a managed-care plan, in which insurers receive a fixed rate per person to handle their medical care. The goal is to control costs and better coordinate care.

In anticipation of the Obamacare rollout, officials in California and elsewhere boosted their payments to managed-care companies because they expected Medicaid costs to increase as newly insured patients rushed to the doctor or emergency room after going years without coverage. But those sharply higher costs didn’t materialize — and insurers pocketed more money as a result, especially in California. LATimes

W0w -Gigantic Profits!

Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry.

But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds that patient care is subpar.

Health Net, a unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profit from 2014 to 2016, according to state data obtained by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California’s Medicaid program in the same period.

Overall, Medicaid insurers in the Golden State made $5.4 billion in profits from 2014 to 2016, in part because the state paid higher rates during the inaugural years of the nation’s Medicaid expansion under the Affordable Care Act, or Obamacare. Last year, they made more money than all Medicaid insurers combined in 34 other states with managed care plans.  LATimes

Kentucky Audit Shows $72 Million In Medicaid Payments Made to Ineligible Beneficiaries

Liberals have said numerous times that it is impossible for illegal immigrants to receive taxpayer-funded government benefits.

A Kentucky audit shows a failure.

An estimated $72 million in Medicaid payments were made to potentially ineligible beneficiaries in Kentucky, according to an audit from the agency’s inspector general…

The Audit

The audit found the state determined eligibility status for Medicaid benefits without having such documentation and could not show that they received a citizenship verification response from the Social Security Administration.

In order to receive Medicaid benefits, the state must verify citizenship or nationality status and have documentary evidence. The state can conduct this verification process through the Social Security Administration…

To properly verify citizenship or nationality status of beneficiaries enrolled in Medicaid, States must ensure that those individuals declaring to be citizens or nationals of the United States have presented satisfactory documentary evidence of citizenship or nationality…

For 7 of 120 beneficiaries, the State agency determined these beneficiaries eligible for Medicaid without maintaining documentation that it verified citizenship in accordance with Federal requirements. For these beneficiaries, the State agency submitted their citizenship status through the Data Hub or BENDEX for verification with SSA. However, the State agency could not provide documentation that it had received a citizenship verification response. The State agency indicated that, because of human error and system errors, it could not find supporting documentation…

The State agency did not always verify identity or maintain documentation from identity-proofing of beneficiaries. For 13 of 50 beneficiaries that applied using the State marketplace, the State agency did not verify identity during the application process or document that it had performed identity-proofing in accordance with Federal requirements.

Did Not Verify Identities

For nine beneficiaries, State agency personnel completed the application either online or over the phone and did not verify identity. The State agency was unable to provide any documentation indicating that personnel followed Federal requirements to verify identity for these online or phone applications.

For four beneficiaries, the State agency either did not verify identity or did not maintain documentation of the verification because of Kynect system errors…

On the basis of our sample results, we estimated that during our 6-month audit period, approximately 8% of non-newly eligible beneficiaries in Kentucky were potentially ineligible, and approximately 3% of Federal payments were made to those beneficiaries. As a result, we estimated that Kentucky made Federal Medicaid payments on behalf of 69,931 potentially ineligible beneficiaries totaling $72,763,721.  FreeBeacon