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'Duplicate' Medicaid enrollees cost Kentucky $836M, auditor general counsel says

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Pen, spectacle and notebook written with TAKE ACTION. Keep moving, opportunity, chance and time flies concept.

Kentucky lawmakers heard testimony Thursday on duplicate enrollees in Medicaid, who may be listed in Kentucky and other states.

Individuals enrolled in Medicaid should only be listed under one state, but Alex Magera, general counsel for the state auditor's office, said by their numbers covering a period of years, the problem has been significant.

"One thing that we found is that Kentucky has paid over $836 million for individuals who are also being serviced by another state's Medicaid system," he said.

The finding came as part of an investigation that stretched back to the previous state auditor and was initiated by request of the Biden administration, which was trying to figure out why the problem was occurring across the country.

While Magera began his testimony discussing waste, fraud, and abuse, he noted much of the data was collected during the pandemic.

Tom Stevens, President and CEO of the Kentucky Association of Health Plans, said that variable is key to understanding the issue.

"During that period, states operated under federal requirements that significantly limited their ability to disenroll Medicaid members as a condition of continuing enhanced federal funding," he said. "That doesn't mean overlapping enrollment should be ignored. It does mean we need to understand what caused it."

Stevens also said the identification of a duplicate enrollment does not necessarily mean an improper payment occurred.

Since the pandemic, Kentucky officials say the landscape has dramatically improved when it comes to the duplicate issue, though all parties involved are waiting to see if the state's new Medicaid enrollment requirements passed during the 2026 session provide sufficient guardrails to prevent the problem from happening again.