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Medicaid Eligibility Matters

Gary Alexander
Director Medicaid and Health Safety Net Reform Initiative at Paragon Health Institute

A nationally recognized health services expert and government reformer, Gary D. Alexander is head of the Medicaid and Health Safety Net Initiative at the Paragon Health Institute.

Elizabeth Stelle

Director Medicaid and Health Safety Net Reform Initiative at Paragon Health Institute
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Should a health-care program for low-income seniors, the disabled, kids, and pregnant mothers be co-opted by hundreds of thousands of healthy adults? Adults not even eligible for assistance? Since March 2020, that’s been the reality for the Medicaid program.

But this spring, states regained their ability – for the first time in three years – to clean eligibility rolls and preserve Medicaid benefits for those who need them most.

At the outset of COVID-19, the federal government pressured and coerced states to stop routine Medicaid eligibility redeterminations in return for enhanced funding as part of the Public Health Emergency (PHE). That ended on March 31 of this year, and April saw states once again begin the formidable process of confirming participant eligibility.

It’s about time. A recent Paragon Health Institute study estimated that upwards of 18 million ineligible adults are using Medicaid. In Pennsylvania alone, more than 600,000 recipients are likely ineligible for Medicaid, and many of these ineligible recipients have other forms of insurance.

In short, states like Pennsylvania will spend hundreds of millions on care for noneligible adults, while truly disabled individuals seeking care in a community setting sit on waiting lists.

The full article can be found in RealClear Pennsylvania.

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