Tag: eligibility fraud

Since January 27, 2020, the federal government has been operating under a Public Health Emergency (PHE) related to the COVID-19 pandemic. On January 14, 2022, this PHE was renewed for an eighth time. While we are currently in the midst of the omicron surge, some suggest that we may be nearing the beginning of the end of the pandemic — and thus the inevitable expiration of the PHE. Impacts of the PHE While the PHE remains in effect, states must maintain current Medicaid enrollees, regardless of changes to their eligibility status. A recent report showed Medicaid enrollment increased 16.8% from February 2020 to June 2021. This is counter to the previous trend, where enrollment declined from 2017 to 2019. Furthermore, the average per capita Medicaid cost to states is estimated at $5K–$10K (states share about one-third of the cost of Medicaid). The combination of the per capita expense and the increased number of enrollees during the pandemic translates to a significant impact on state budgets. Once the federal order expires, states will have 12 months to redetermine eligibility for continued enrollment in the program, or risk bearing 100% of the associated cost. Processing redetermination in a timely manner is critical for states to avoid unnecessary expenditures and to ensure that citizens are receiving access to the correct services. It’s imperative that states start planning for redetermination of benefits for continued Medicaid coverage as soon as possible to be prepared to take action at the inevitable conclusion of the PHE. Preparing for redeterminations At the end of the PHE, states will need a system to easily and confidently review their current Medicaid rolls to confirm eligibility. Implementing this system will likely involve working with a trusted partner who can provide tools and advantages such as: Portfolio analysis Real-time analysis Verification of income and employment Compliance adherence Affordability With the correct systems in place, states can act quickly once the PHE ends, saving unnecessary expenditures and providing better services to citizens in need. If your state agency would like to learn more about how Experian can assist with citizen benefit redetermination efforts, visit us or request a call. Learn more

A recent survey of government benefit agencies shows an increased need for fraud detection technology to prevent eligibility fraud. Only 26 percent of respondents currently use fraud detection technology, and 57 percent cite false income reporting as the leading cause of fraud. Insufficient resources and difficulty integrating multiple data sources were the greatest challenges in preventing eligibility fraud.