Opinion - What to do about $1.1 trillion in improper Medicaid payments
As the 119th Congress seeks to reduce government spending through reconciliation, talk of Medicaid reductions has raised concerns about vulnerable populations losing Medicaid coverage. But simply following the law and paying only for what Medicaid allows would save hundreds of billions of dollars without ending coverage for any of Medicaid's intended recipients.
According to official reports, the government issued $543 billion in improper Medicaid payments from 2015 to 2024. But that's only what the government measured.
Based on the few years that the government performed full audits, I coauthored a report with Paragon Health Institute President Brian Blase that estimated that the true amount of improper payments is twice that, totaling roughly $1.1 trillion over the last decade. That's a whopping $8,200 per U.S. household.
The primary reason for the discrepancy is that the Obama and Biden administrations excluded eligibility checks in their audits of improper payments in Medicaid. But eligibility errors and failures to properly assess eligibility prior to enrollment are the biggest sources of improper payments.
Since Medicaid is a means-tested welfare program and includes different federal reimbursement rates based on enrollees' eligibility status, checking eligibility is crucial. In many cases, individuals who are not eligible for the program are enrolled in it, and in other instances, those enrolled are wrongly classified.
The federal government reimburses states for between 50 percent and 75 percent of Medicaid costs for their traditional Medicaid enrollees — which includes children, pregnant women, seniors and individuals with disabilities — with lower rates in wealthier states. The Affordable Care Act expanded Medicaid to able-bodied, working-age and generally childless individuals, which crowded out access to care for traditional enrollees.
Because expansion enrollees receive a much higher 90 percent federal reimbursement, states have the incentive to wrongly classify traditional enrollees as expansion enrollees.
Moreover, hospitals can use presumptive eligibility, which is an expedited Medicaid enrollment process that permits hospitals to essentially enroll people into Medicaid based on only a few questions about income and household size and without verification. People receive temporary Medicaid coverage pending a review.
The Foundation for Government Accountability found that in 2018, 70 percent of people deemed eligible by hospitals were eventually determined ineligible or did not complete the application and have their information verified.
Measures taken during the COVID-19 pandemic — including increasing federal support of Medicaid so long as states did not update their eligibility requirements or remove ineligible people from the program — led to an estimated 20 million ineligible enrollees on Medicaid by the time President Biden finally declared an end to the public health emergency.
Failing to even check for these eligibility errors in state Medicaid audits causes massive underreporting of improper payments. In 2019 and 2020 when the government conducted full audits that included eligibility determinations, the improper payment rates averaged 27 percent.
When we apply a 25 percent improper payment rate for all years between 2014 and 2023, we estimate roughly $1.1 trillion in improper Medicaid payments.
Much of this is money that should not have been spent if the federal and state governments were following the law. Congress enacted legislation directing the Health and Human Services secretary to push the cost of excessive improper payments back onto states by withholding federal funds for improper payments over three percent. Despite states routinely issuing improper payments many times that level, HHS has never withheld funds under that requirement.
To automatically incorporate accountability into improper payment rates, Congress should require CMS to reduce future federal Medicaid reimbursements to high-offender states so those states, which are responsible for managing the programs, bear the cost of their failures instead of federal taxpayers.
Moreover, to prevent underreporting of improper payments, federal policymakers should require states to conduct more frequent eligibility redeterminations, improve hospitals' presumptive eligibility enrollment and require full audits of improper payments including eligibility checks.
Many changes are necessary to improve Medicaid and protect the integrity of federal taxpayers' spending on it. Following the law and cracking down on improper payments is a common sense first step that could provide hundreds of billions of dollars in Medicaid savings.
Rachel Greszler is a visiting fellow in workforce at the Economic Policy Innovation Center and co-author with Brian Blase of the report, 'Medicaid's True Improper Payments Double Those Reported by CMS.'
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Business Wire
2 hours ago
- Business Wire
CCS Presents Four Peer-Reviewed Posters at American Diabetes Association's 85th Scientific Sessions
CHICAGO--(BUSINESS WIRE)-- CCS, a leading provider of clinical solutions and home-delivered medical supplies for those living with chronic conditions, will present four peer-reviewed posters at the American Diabetes Association's (ADA) 85th Scientific Sessions, which will take place June 20–23 in Chicago. These latest poster presentations illustrate CCS's focus on delivering evidence-based approaches to diabetes care management that ensure patients have the education and coaching they need to thrive and cost-effectively stay adherent while managing their chronic condition. "At CCS, we meet patients where they are — with empathy, education, and evidence-based support..." Share The ADA Scientific Sessions is a globally recognized conference dedicated to advancing the field of diabetes. This annual meeting serves as a critical forum for presenting cutting-edge research, innovation, and new evidence-based approaches to diabetes prevention, management, and care. Presentation Highlights from CCS at the ADA Scientific Sessions CCS's clinical strategy and innovation vice president, Coni Dennis, DNP, RN, and NE-BC, will present findings for all four accepted poster presentations at the ADA's 85th Scientific Sessions, and she shared this insight leading into the event: 'At CCS, we meet patients where they are — with empathy, education, and evidence-based support. These poster presentations reflect our commitment to improving health outcomes for people with diabetes by combining data-driven clinical insight with hands-on, compassionate care.' All poster presentations will take place at the conference on Sunday, June 22, from 12:30–1:30 p.m. CT in West Hall F1. The following are the four specific posters that CCS will be presenting: Presentation Title: Evaluating the Impact of Multichannel Diabetes Care Coaching and Education in Patients New to Continuous Glucose Monitoring Abstract Number: 534 Summary: This study, part of an ongoing randomized control trial (RCT), evaluated whether adults with diabetes newly starting a continuous glucose monitor (CGM) achieve better outcomes when they receive diabetes self-management education and support (DSMES) from a certified diabetes care and education specialist (CDCES), compared to using a CGM alone. Presentation Title: Examining the Impact of Continuous Glucose Monitoring Sourcing in Medicaid Patients — Adherence, Healthcare Costs, and Utilization Abstract Number: 1046 Summary: This study compared healthcare costs and utilization among Medicaid beneficiaries who received CGM supplies through a pharmacy or a durable medical equipment provider. Presentation Title: Healthcare Costs and Utilization Among Patients Eligible for Continuous Glucose Monitors — A Comparison of Users and Nonusers Abstract Number: 1049 Summary: This retrospective cohort study used claims data to compare glycemic control, healthcare utilization, and total cost of care over 12 months among individuals on bolus insulin who used CGMs versus those who did not. It also assessed the incidence of hypoglycemia and diabetic ketoacidosis (DKA). Presentation Title: Evaluating an Evidence-Based Quality Improvement Initiative for Food Insecurity Screening and Referral in Adults with Diabetes Initiating Continuous Glucose Monitor Therapy Abstract Number: 1143 Summary: This study assessed food insecurity (FI) among adults with diabetes initiating CGM therapy, comparing rates to national averages and examining glycemic outcomes between food-insecure and food-secure individuals. These posters will be made available on the American Diabetes Association's website after August 25. About CCS CCS is the strategic partner addressing America's most pressing healthcare challenges through intelligent chronic care management, tackling the $412 billion annual diabetes burden and chronic conditions affecting over 133 million Americans. At the core of CCS's differentiated model is LivingConnected®, a human-led, digitally enabled clinical solution. PropheSee™ — an AI-powered predictive model that identifies nonadherence risk and delivers personalized interventions — is an integral part of this solution, creating a first-of-its-kind platform to improve adherence, enhance clinical outcomes, and help prevent costly hospitalizations. By combining data-driven insights with three decades of industry relationships, CCS is the smart choice for health plans, providers, employers, and manufacturers who believe that value-based care starts by keeping patients healthy and delivers benefits like lower cost of care, improved HEDIS scores, and alleviating provider burnout. CCS's approach extends clinical reach while supporting over 200,000 people nationwide with home-delivered medical supplies and pharmaceuticals annually. Recognized as a Great Place to Work® and with numerous peer-reviewed publications validating our care management approach, CCS is more than a trusted supplier — we're a partner in transforming chronic care delivery. To learn more about how CCS is addressing today's healthcare challenges, visit or connect with us on LinkedIn.
The Hill
2 hours ago
- The Hill
Thune faces pressure from right flank
The Big Story The Senate version of legislation to enact President Trump's agenda is hitting new turbulence as conservatives led by Sens. Ron Johnson (R-Wis.), Rick Scott (R-Fla.) and Mike Lee (R-Utah) are demanding deeper spending cuts to address the nation's $2.2 trillion annual deficit. © The Associated Press Senate Majority Leader John Thune (R-S.D.) has focused this week on addressing the concerns of Senate GOP colleagues such as Sens. Josh Hawley (Mo.) and Lisa Murkowski (Alaska), who raised alarms about cuts to federal Medicaid spending. But Thune has to worry about his right flank as Johnson and his allies are threatening to hold up the bill unless GOP leaders agree to deeper cuts to federal Medicaid spending and a faster rollback of the renewable energy tax credits enacted under former President Biden. Johnson, Lee and Scott are threatening to vote as a bloc against the bill next week unless it undergoes significant changes. Thune plans to bring the bill to the floor Wednesday or Thursday next week, but he may not have enough votes to proceed on the legislation, Republican senators say. The Hill's Alex Bolton has more here. Welcome to The Hill's Business & Economy newsletter, I'm Sylvan Lane — covering the intersection of Wall Street and Pennsylvania Avenue. Did someone forward you this newsletter? Subscribe here. Essential Reads Key business and economic news with implications this week and beyond: Trump: 'Maybe I'll have to change my mind' about firing Powell President Trump on Friday floated the possibility of firing Federal Reserve Chair Jerome Powell as part of his latest round of intense criticism of the leader of the central bank over its decision not to lower interest rates. 1 in 3 baby boomers say they'll never sell home: Redfin About a third of baby boomers who own their homes don't expect to ever part with them, according to a new poll. NTSB recommends quick modifications to 737 Max engines The National Transportation Safety Board (NTSB) on Wednesday recommended that Boeing modify the engines on 737 Max planes due to a safety problem caused by bird strikes. Nearly 1,000 ships see GPS jams near Iran coast, group says Nearly 1,000 ships have experienced 'persistent and sometimes severe' GPS signal jams every day the past week near Iran as the country continues to face bombardment from Israel's military, a French naval monitoring firm warned Friday. The Ticker Upcoming news themes and events we're watching: In Other News Branch out with more stories from the day: Senate parliamentarian deals blow to GOP plan to gut consumer bureau in tax bill WASHINGTON (AP) — Republicans suffered a sizable setback Friday on one key aspect of President Donald … Good to Know Business and economic news we've flagged from other outlets: What Others are Reading Top stories on The Hill right now: Senate parliamentarian knocks pieces out of Trump's megabill Senate Parliamentarian Elizabeth MacDonough has ruled that several key pieces of the massive bill to implement President Trump's agenda run afoul of the Byrd Rule and must be taken out of the package to allow it to pass with a simple majority vote on a special procedural fast track. Read more Supreme Court rules against FDA, EPA 12:30 Report is The Hill's midday newsletter. Subscribe here or using the box below: Read more You're all caught up. See you next week! Thank you for signing up! Subscribe to more newsletters here
Yahoo
2 hours ago
- Yahoo
Fox News Poll: Voters distrust Biden administration on president's mental fitness
Voters say they were aware of former President Joe Biden's decline, and believe the administration lacked honesty and transparency about his mental fitness, with many wanting Congress to investigate the matter. A new Fox News survey finds more than half, 52%, think it is important to investigate whether Biden advisors used an autopen without the president's awareness, while 46% say it's time to move on. House Oversight Committee Chair James Comer is pursuing investigations against former Biden administration staff for allegedly covering up Biden's mental decline and using an autopen for executive actions. Views are split on whether advisors should be scrutinized for making key presidential decisions on behalf of Biden (50% investigate vs. 49% move on), while a majority opposes investigating whether Biden advisors covered up his decline (44% investigate vs. 55% move on). Fox News Poll: Voters Think Iran Poses A Real Threat To Us Security, But Split Oj Israel's Strike Among Democrats, one in five supports investigating whether there was a cover-up, while roughly one in four feels that way about using the autopen and making presidential decisions. Read On The Fox News App Overall, 68% of voters believe the previous administration was dishonest about Biden's condition, including 52% of Democrats, 75% of Independents, and 81% of Republicans. Fox News Poll: Economic Pessimism Abates Slightly As Voters Reflect On The Economy Yet, while a majority agree there was a cover-up, they weren't fooled. Nearly 7 in 10 say they were aware of Biden's cognitive condition even before his jaw-droppingly bad debate performance in June 2024. Some 28% say they knew he was in decline as soon as he took office, 21% say a couple of years into his term, and 19% after he started running for re-election. Another 20% knew of Biden's decline after his debate with Donald Trump. Fewer than 1 in 10 say he wasn't in decline (9%). These numbers are consistent with what voters said throughout Biden's term. As early as November 2021, only one year after Biden was elected, Fox News surveys found that a 53% majority thought his age was interfering with his job as president, including more than one-quarter of Democrats. By the 2022 midterms, our Fox News Voter Analysis election survey found 57% of voters felt Biden lacked the mental capability to serve and, by July 2024, that grew to 65%. "Somewhat lost in the kerfuffle about the exact timing of Biden's decline is the fact that most knew he was losing it and had factored this into their vote choice long before the presidential debate," says Daron Shaw, a Republican who conducts the Fox News survey along with Democrat Chris Anderson. "Still, Biden's reputation and legacy are clearly taking a hit as the real history of his administration is revealed." Biden's current personal favorability is underwater by 13 points (43% favorable, 56% unfavorable), compared to -19 points in January. During the early days of his presidency, his ratings were net positive by 10 points (54% favorable, 44% unfavorable, April 2021). Today, 75% of Democrats have a positive view of Biden, down from 95% four years ago. CLICK HERE FOR Crosstabs AND Topline Conducted June 13-16, 2025, under the direction of Beacon Research (D) and Shaw & Company Research (R), this Fox News survey includes interviews with a sample of 1,003 registered voters randomly selected from a national voter file. Respondents spoke with live interviewers on landlines (149) and cellphones (566) or completed the survey online after receiving a text (288). Results based on the full sample have a margin of sampling error of ±3 percentage points. Sampling error for results among subgroups is higher. In addition to sampling error, question wording and order can influence results. Weights are generally applied to age, race, education, and area variables to ensure the demographics are representative of the registered voter population. Sources for developing weight targets include the American Community Survey, Fox News Voter Analysis, and voter file data. Fox News' Victoria Balara contributed to this article source: Fox News Poll: Voters distrust Biden administration on president's mental fitness
