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Mismanaging Medicaid, One Improper Payment at a Time

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Brian Blase
PresidentatParagon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and serves as its CEO.

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One in 7 Californians with income above eligibility levels reported enrollment in Medicaid in 2017.

This letter to the editor appeared in The Wall Street Journal.

The government is massively mismanaging Medicaid (“Build Back Better? Fix Medicaid First,” Review & Outlook, Jan. 24). Annual improper federal payments, driven by inappropriate or nonexistent eligibility determinations and keeping ineligible people on the program, are estimated at $100 billion. A study I did with University of Kentucky economist Aaron Yelowitz found that 1 in 7 Californians with income above eligibility levels reported enrollment in Medicaid in 2017.

ObamaCare’s Medicaid expansion deserves much of the blame, since Washington pays nearly the entire cost of spending on expansion enrollees. A recent federal audit examined 2,301 files of people enrolled under ObamaCare’s expansion, and eligibility review errors occurred in 29% of them. About half were caseworker mistakes, about a quarter were “system failures,” and the rest couldn’t be determined.

Iowa, South Dakota and Washington have Medicaid improper payment rates below 5%. Determining proper eligibility is not impossible. To encourage states to put proper eligibility systems in place, the federal government must appropriately estimate and recover misspent funds.

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