In its most recent review of the Louisiana Department of Health and its Medicaid program, the Legislative Auditor reviewed the Department’s efforts to ensure Medicaid eligibility through more frequent review of enrollee income.
The audit noted the Department has established a process to conduct more frequent wage data checks which has improved its ability to ensure that only eligible individuals are enrolled in the program.
As outlined in the audit, the Department has entered into a data sharing agreement with the Louisiana Workforce Commission that has allowed for more frequent wage verification checks, replacing a previous practice that relied on recipients to self-report changes in income.
With this change, LDH was also able to identify and refer potentially fraudulent cases to the Attorney General’s Office. These cases are currently under investigation. Per federal requirements, LDH will seek to recoup money from Medicaid recipients convicted of committing fraud.
LDH conducted its first quarterly wage check in February 2019 and mailed letters to 40,000 recipients who appeared to have wages higher than the allowable amount. Initially, about 30,000 of those recipients ultimately lost coverage.
However, “The vast majority of the closures were for enrollees’ failure to respond to the Department’s request for information, rather than evidence of current ineligibility,” said Jen Steele, Medicaid Director. “Since then, 7 % of the 40,000 enrollees who received a request for information have provided proof of eligibility and have been re-enrolled in coverage.”
LDH is working on strategies to improve member communications and member responsiveness as a means to reduce coverage termination for purely procedural reasons, such as a failure to respond to a request for information.