re: Audit: Louisiana spent $112 million+ on Medicaid for people who don’t live in Louisiana

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Is the state supposed to double check the private companies?

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Uhh yeah

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Remember, we privatized Medicaid. If the private companies told the state someone was eligible, the state paid them. Is the state supposed to double check the private companies?

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The privatization is only for administration of benefits. The state manages eligibility for nations and is the only entity who can remove someone from the Medicaid rolls. The private managed care organizations can and do report beneficiaries to the state who seem to have moved out of state. However, if those members receive services out of state the MCO is obligated to treat them as eligible beneficiaries and enter into single case agreements with the provider when possible.

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Remember, we privatized Medicaid.

If the private companies told the state someone was eligible, the state paid them.

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Louisiana absolutely did not privatize Medicaid. Managed Care Organizations have nothing to do with determining Medicaid eligibility they just get a monthly payment from the state to administer services. So instead of the State paying for 100% of the costs of Medicaid services an individual receives the State pays a single fee per person each month to the MCOs who then pay for the services.

The State still determines Medicaid eligibility and sends that eligibility information to the MCOs. It's the States fault for not verifying the residency of these individuals.