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Senate hearing examines state auditor recommendations to reduce improper Medicaid concurrent enrollment payments
Summary
Senate Bill 5258 would implement portions of a state auditor report aimed at identifying and recovering Medicaid premiums paid for enrollees concurrently enrolled in multiple states. Sponsors, HCA staff, plans and advocates debated likely savings and risks to vulnerable enrollees.
Senate Bill 5258, introduced by Senator Chris Gildon and heard Jan. 24, would implement several recommendations from the Washington State Auditor’s October 2024 performance audit on concurrent Medicaid enrollments. Committee staff said the audit found more than 131,000 people were concurrently enrolled in Medicaid managed care in Washington and at least one other state during 2019–2022, and that Washington paid an average of about $8.6 million per year on unnecessary premiums for clients residing in seven reviewed states.
Julie Tran, committee staff, summarized the bill’s six main elements: require the Health Care Authority to amend contracts and processes to recover premiums for clients later determined to be residents of another state; require HCA to identify monthly instances of multi‑state enrollment; direct HCA and DSHS to coordinate to notify HCA when clients move out of state; seek federal clarification from SSA and CMS about SSI recipients’ residency determinations; run Medicaid client lists quarterly through the USPS National Change of Address database; and ensure plain‑language notices and address‑service‑requested mailings. The bill also would require a follow‑up performance audit by the state auditor by Dec. 31, 2031.
Sponsor Senator Chris Gildon said the bill “seeks to implement the recommendations of the state auditor” and characterized concurrent enrollments as a “leaky faucet” in government that “can be fixed.” He noted the audit’s potential savings could extend beyond premiums because concurrent enrollees often also receive other state benefits.
HCA’s Evan Klein told the committee that the audit relied on data from 2019–2022 when pandemic‑era redetermination processes were paused and urged caution about overstating potential savings. He noted Medicaid premia are paid as capitation (per‑member‑per‑month) and that reducing enrollment counts can change per‑member payments and interact with existing risk‑corridor and reconciliation mechanisms. He said HCA has concerns about potential conflicts with new federal rules coming into effect.
The Association of Washington Healthcare Plans’ Jennifer Ziegler said plans are committed to stewardship of taxpayer dollars and recommended codifying CMS guidance on using the USPS National Change of Address database; she also urged the committee to consider the state’s risk‑corridor processes when estimating savings.
Vanessa Vadra of Northwest Health Law Advocates opposed the bill as written, arguing the National Change of Address database is not a reliable indicator for people experiencing homelessness, fleeing domestic violence, or otherwise in unstable housing, and that aggressive recovery could place vulnerable residents at risk of losing coverage. She also cited the auditor’s conclusion that only marginal improvements are achievable at the state level and that federal action is necessary for a comprehensive solution.
Committee members did not take a final vote on SB 5258 during the hearing; testimony was taken under a one‑minute time limit to accommodate a large number of sign‑ins.
