By: CA Staff Writer | March 5, 2025
Clarksdale, Mississippi – A recent social media post from the Mississippi Office of the State Auditor has reignited discussions about Medicaid eligibility in the state. Findings from an audit conducted a few years ago revealed that approximately 5% of Medicaid recipients were ineligible due to excessive income levels. According to the Office of the State Auditor (OSA), some individuals living in million-dollar homes and earning six-figure incomes were still receiving Medicaid benefits. While 5% may seem like a small percentage, this translates to an estimated $60 million to $140 million in improper payments annually (OSA, 2020 Single Audit Report).
Audit Findings on Medicaid Eligibility
The audit, part of the Single Audit Report for the 2020 fiscal year, reviewed a sample of 180 Medicaid beneficiaries. According to Mississippi Today, nine individuals (5%) had incomes exceeding the eligibility threshold by an average of $10,727. Additionally, the audit flagged two individuals who owned multi-million-dollar homes as potential fraud cases (OSA, 2020). These findings suggest that Mississippi could save millions of dollars by preventing ineligible individuals from receiving Medicaid benefits (Mississippi Free Press).
A significant issue identified in the audit is the Mississippi Division of Medicaid’s lack of legal authority to access state income tax returns. According to OSA and Mississippi Today, this limitation makes it difficult for the agency to verify applicants’ income accurately, potentially allowing high-income individuals to access Medicaid benefits meant for low-income residents.
State Auditor Shad White has emphasized the need for legislative action to grant the Division of Medicaid access to state tax returns, which would allow for more accurate income assessments. This recommendation aligns with the agency’s internal policies, which advocate for stricter income verification measures (OSA, Medicaid.ms.gov).
Medicaid Eligibility Criteria in Mississippi
Medicaid is a government-funded program that provides health coverage to low-income individuals, including children, parents or caretakers of minor children, pregnant women, and aged, blind, or disabled individuals. Eligibility is based on income relative to the Federal Poverty Level (FPL). According to Medicaid.ms.gov, as of March 1, 2024, income limits for Medicaid eligibility in Mississippi are:
- Infants (birth to age 1): Up to 194% of the FPL
- Children (ages 6-19): Up to 133% of the FPL
- Pregnant women: Up to 194% of the FPL
These income thresholds are set to ensure that Medicaid serves those who need it most. However, the OSA audit suggests that some high-income individuals are bypassing these regulations, raising concerns about proper oversight and enforcement (Medicaid.ms.gov).
The audit’s findings have sparked debates among advocacy groups. Some critics argue that the reported 5% ineligibility rate may be misleading due to the small sample size of 180 beneficiaries (Mississippi Free Press, Picayune Item). They caution against assuming widespread fraud without more comprehensive verification. Additionally, some advocacy groups emphasize that while preventing fraud is necessary, it is equally important to ensure that eligible individuals are not wrongfully denied benefits (Mississippi Today).
The identification of ineligible Medicaid recipients highlights the need for stronger verification processes to prevent improper payments. Granting the Mississippi Division of Medicaid access to state tax returns could significantly improve income verification and help prevent the misuse of funds.
According to OSA and Medicaid.ms.gov, such measures would safeguard the integrity of the Medicaid program, ensuring that financial resources are directed to Mississippi’s most vulnerable populations. While the 5% ineligibility rate might seem small, improving income verification processes is a crucial step toward preserving the program’s financial sustainability.
The audit findings highlight the importance of maintaining Medicaid’s integrity by ensuring that only eligible individuals receive benefits. Addressing income verification challenges through legislative action and enhanced oversight will help ensure that Medicaid continues to serve those who truly qualify (OSA.ms.gov, Mississippi Today).
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