A tale of two states: When it comes to Medicaid sustainability, Illinois and Oklahoma are more alike than not
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Published: 02-Apr-2013

OKLAHOMA CITY -- In the Land of Lincoln, an effort at “Scrubbing Medicaid” is quickly drawing attention even in Oklahoma.

The Sooner State economy is relatively robust, while Illinois’ challenges in pension financing and provision of core services have become fodder for late-night television humorists, and others. 

In Illinois, state officials have embraced the Affordable Care Act, including Medicaid expansion, whereas the leadership of Oklahoma is working to avoid the massive expansion envisioned in President Barack Obama’s signature legislation.

What Oklahoma and Illinois share, however, is a growing sense of dread about the long-term sustainability of Medicaid. 

Prodded by the state Legislature, the Illinois state Department of Healthcare and Family Services launched an investigative audit to identify ineligible Medicaid recipients, as part of a push to save $1.6 billion – not as part of a plan to reduce spending, but to assure the money saved goes to intended recipients under existing law.

This was an essential step, state officials said, to preserve the program, upon which thousands of low-income people rely for health insurance coverage.

Benjamin Yount, writing for Illinois Watchdog, said despite the projected savings push the state faces “a metaphorical ‘train wreck’ … just around the bend.” 

Two-thirds of the initial 20,500 recipients screened in Illinois – 13,709 people in all – should be removed from Illinois Medicaid, according to an outside contractor studying the state program for the agency. Those found ineligible in the first round of screening either make too much money or do not even live in the state. 

Julie Hamos, head of the Heathcare agency, told The Chicago Tribune editorial board the first round of investigation concentrated on “low-hanging fruit,” that is, thousands of “accounts” previously red-flagged by agency staff. 

Context for the investigation comes from the growth of Medicaid in Illinois from 1.4 million recipients in 2000 to 2.8 million today – more than one in five state residents. Trouble is, under the Affordable Care Act, officials estimate 342,000 more Illinoisans will become eligible for Medicaid.  

Responding to the Illinois investigation, fiscal analyst Jonathan Small of the Oklahoma Council for Public Affairs (OCPA) told CapitolBeatOK that state government officials should undertake a similar “scrubbing” here. He reflected: 

Oklahoma needs to make a robust effort to make sure that those who are enrolled in Medicaid actually qualify, even after initial qualification-such as on an annual basis. Based on Oklahoma's income and population growth over the last ten years, the way our Medicaid rolls are growing don't make sense.

According to the IRS, we are seeing average in-migration at household incomes above that which is necessary to qualify for Medicaid. State tax commission data shows that more and more tax returns fall into categories above qualification for Medicaid. This is not even to mention that Oklahoma is currently in the top five states as far as lowest unemployment rate.

“It makes no sense that in Oklahoma, our Medicaid enrollment population has gone from about 13 percent of the population to over 26 percent in just 12 years, even when you account for the number of both legislative or Healthcare Authority driven Medicaid expansions.” 

Small insisted, “This is another example of exactly why Oklahoma needs Medicaid reform and the Oklahoma Health Care Authority needs to be solely focused on managing (especially focusing on enrollment integrity) and not growing a welfare entitlement program.”

You may contact Patrick B. McGuigan at Patrick@capitolbeatok.com and follow us on Twitter: @capitolbeatok.


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