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JLARC Report Finds Trouble in Medicaid System

Lawmakers in Richmond today heard a report… saying Virginia is likely spending millions in state-funded healthcare for people who don't actually qualify for the benefits.

There’s no specific number for how much Virginia is spending on Medicaid that it shouldn’t… but there is an estimate for one aspect of the program that can give officials a sense.

To be eligible for Medicaid you have to re-apply every year… and there’s a huge backlog of those applications.

“And so logically some of those individuals are going to be ineligible and they’re just not going to be checked until later.”

Jeff Lunardi  is in charge of the state’s review of Medicaid. He and his team combed through those applications for one year and estimated how much the state had spent on people who turned out to be ineligible.

“And our estimate indicated that between about 21 million and 38 million dollars was spent on those individuals who were late and were ineligible and hadn’t been checked yet. And that’s state and federal funds, so about half of that is state funds.”

It’s difficult to qualify for Medicaid in Virginia.  Low income parents, children, pregnant or disabled people can get healthcare through the program, but very poor adults cannot. Then there are income requirements, which may seem cut and dry...

“However, the income that you receive that counts towards that and the actual threshold relative to federal poverty has a lot of variables involved.”

For instance veterans benefits--or child support--  doesn’t count as part of your income. And the threshold depends on how many people are in your household, which, for children who compose half of  Medicaid recipients in the state.. can be complicated depending on your family situation and who you live with.

“So yes the line in the sand so to speak of what the criteria is  simple, but understanding all the circumstances of an individual and how that relates to that criteria is complicated.”

And if someone reports their income as zero -- the state doesn’t verify it at all.

“State policy just directs the eligibility worker to take that at face value, at what the client says.”

This is the first part of a multi-year review of Virginia’s Medicaid -- coming at a time when the program is under close political scrutiny.

Democratic Governor Terry McAuliffe has led efforts to get more people covered under Medicaid, which would be mostly paid for with federal dollars, through the Affordable Care Act.

But those attempts have stalled quickly in Virginia’s Republican-controlled legislature -- which has instead focused on reducing the cost of the program.


Mallory Noe-Payne is a Radio IQ reporter based in Richmond.
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