A recent audit revealed staggering losses in Kansas' Medicaid program, with estimates suggesting that up to $550 million could be lost annually to fraud. The Senate Committee on Government Efficiency convened on January 28, 2025, to discuss these alarming findings, which highlight significant lapses in oversight and management within the Kansas Department of Health and Environment (KDHE).

The audit uncovered that $1.6 million in Medicaid claims were improperly paid to 912 beneficiaries who had exceeded the program's strict 12-month lifetime limit. Following this revelation, KDHE began removing 556 ineligible individuals, resulting in immediate savings of $1.2 million. Additionally, the audit identified $1.3 million in capitation payments made for deceased beneficiaries, some of whom had been dead for up to five years.

Further scrutiny revealed that over 2,000 individuals enrolled in the Home and Community-Based Services (HCBS) program had not received any services for more than a year, leading to $193 million in unnecessary capitation payments. Despite these findings, KDHE expressed reluctance to pursue recovery of these funds, citing a restrictive three-month look-back period for recouping payments.

The committee also addressed issues surrounding individuals who fraudulently retained their Kansas Medicaid benefits after moving out of state. It was noted that Kansas Medicaid is perceived as superior to neighboring states, prompting some to misrepresent their residency to maintain access to benefits. The committee emphasized the need for more rigorous eligibility checks and a potential overhaul of the current system to prevent such abuses.

As the committee continues to investigate these issues, the implications of these findings could lead to significant reforms in how Kansas manages its Medicaid program, aiming to safeguard taxpayer dollars while ensuring that those in genuine need receive the support they require.