Audit finds $8M in potential Missouri Medicaid overpayments

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A MO audit found about $7M in managed care payments for out of state patients and another $1M for prisoners not eligible for Medicaid.


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Missouri overpaid as much as $8 million for Medicaid health care for out-of-state residents and prisoners in recent years, according to a state audit released this week.


© Madeline Carter/Tribune Nicole Galloway gives her concession speech after losing the Missouri Governor’s race to Governor Mike Parson at the Tiger Hotel on Tuesday evening.

State Auditor Nicole Galloway’s office found the state overspent as much as $6.6 million for 2,600 on health care for patients with out-of-state addresses through the state’s managed care system between July 2017 and June 2019.

Medicaid is a government program that provides health care coverage for low-income adults, children and people with disabilities. Missouri works with managed care companies as middlemen to provide Medicaid care at a lower cost.

The audit also identified $1.7 million in state payments for 500 patients who were incarcerated for at least some of that three-year period.

Missouri law at the time required the state to kick people off Medicaid when they were jailed or imprisoned. Current law requires Medicaid be suspended for those patients so officials can check to see if they qualify for an exemption.

“At a time when every dollar is being stretched to deliver vital services to Missourians, state government must stop wasting resources,” Galloway said in a statement. “The millions in payments for prisoners and non-Missouri residents is unacceptable.”

Missouri’s Department of Social Services, which oversees Medicaid, said problems with the state’s data system required the agency to exempt some recipients from regular eligibility checks to prevent eligible patients from improperly losing coverage. The agency said staff have been working to check those patients’ eligibility now that data system errors have been fixed and cited annual eligibility checks enacted in 2018.

“This audit confirms that the DSS’ action to implement annual renewals in 2018 and 2019 to verify continued eligibility was the correct action,” the agency wrote in a response included in the audit.

Galloway, a Democrat, on Tuesday lost a bid to unseat Republican Gov. Mike Parson. During her campaign, she frequently criticized his administration for dropping close to 90,000 children from the state’s Medicaid health insurance program.

State officials cited a drop in unemployment and improved efforts beginning in 2018 to purge Medicaid rolls of people who were not eligible. Department of Social Services Acting Director Jennifer Tidball has said that about a third of people who lost coverage didn’t answer letters to renew their eligibility.

This article originally appeared on Columbia Daily Tribune: Audit finds $8M in potential Missouri Medicaid overpayments