Louisiana Department of Health responds to Louisiana Legislative
Auditor Report on Medicaid eligibility and wage verification

Baton Rouge, La. (November 13, 2018) – Today, the Louisiana Legislative Auditor released a report evaluating the Department of Health’s process of using wage data to determine the eligibility of the Medicaid expansion population.

When making Medicaid determinations the Department of Health abides by a CMS-approved verification plan that requires the state to check wages at application and annual renewal. In addition, Louisiana is a “determination state” which means the Federally Facilitated Marketplace (FFM) makes Medicaid determinations and sends the decision to the Department of Health. The FFM does not use Louisiana Workforce Commission data. However, the audit found that in some instances, if Workforce Commission data was used, members would not have been eligible for Medicaid.

Reviewing a sampling of Medicaid recipients and Louisiana Workforce Commission wage data, the audit report found that there are members whose wages exceed the income limit for Medicaid eligibility at some point during their enrollment.

“The Department’s process for determining Medicaid eligibility has been a very manual and time-consuming process based on income information provided by applicants,” said Dr. Rebekah Gee, secretary of the Louisiana Department of Health. “Effective today, and after more than three years of development, the Department has launched a new automated system for Medicaid eligibility and enrollment that will improve customer service, boost efficiency and increase the accuracy of eligibility decisions.”

The new Medicaid eligibility and enrollment system uses advanced technology to ensure that benefits go only to those who meet eligibility and program requirements. The system will connect with state and federal databases to provide more data for real-time verification of citizenship, income, disability and lawful presence in the United States. In addition, it enables consistent enforcement of policy, with timely, automated coverage terminations for non-compliance.

Beginning in January of 2019, the Department will leverage the automation of the new and improved eligibility system that uses Workforce Commission data. The individuals found in this audit will receive closure notices providing an opportunity to report current income. If they do not respond or if the reported income is over the eligibility limit, their Medicaid coverage will be terminated.

In instances where the recipient is determined to have intentionally misrepresented his or her income in order to gain or continue Medicaid eligibility, referrals will be made to law enforcement agencies and recovery of Medicaid payments initiated as appropriate.

The new and innovative eligibility system will make enrollment simpler for patients while improving the accuracy of eligibility determinations, resulting in savings for taxpayers of Louisiana.

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