A series of progress reports from the Louisiana Legislative Auditor provides a convincing demonstration of how data analysis can help improve services to Medicaid clients and potentially save the state money at the same time.

The most recent report, “Medicaid Beneficiaries with No Services,” was released on October 13 and looked deeply into data from the Louisiana Department of Health. It found that 50,000 individuals who were continuously served through Medicaid between January 2018 and December 2024 had received no services but were counted as part of Medicaid membership in the rosters of the six managed care companies that serve the state. Based on per member, per month charges, the state payment to managed care companies for those individuals was $1.23 billion.

While some of the individuals in question may have been healthy and in no need of service, the report raises questions about the lack of medical outreach to others. For example, in a podcast about the report, Chris Magee, data analytics manager for LLA’s Performance Audit Services, said “more than 11,000 of the beneficiaries we identified resided in a rural parish and may have had difficulty obtaining services.”

In addition, he noted that there were “6,300 disabled, aged, or blind beneficiaries for whom $245.5 million dollars in per-member, per-month fees were paid who received no services while enrolled in Medicaid during our audit scope.

For the Louisiana Department of Health, oversight of the quality of care was also a topic of concern to legislative auditors in a report that was released in May 2024. While managed care companies have the responsibility of delivering care to beneficiaries, it is up to the department to monitor the quality of care, as well as the eligibility of participants. 

There were other potential reasons in the October report as to why enrolled  individuals lacked service, with 10,000 beneficiaries also holding third-party or Medicare insurance, potentially indicating that Medicaid coverage was not also necessary.

Two other podcast “progress reports” that were released earlier this year also delved into the reasons that beneficiaries did not receive care. One that was dated August 11 noted that $9.6 million dollars in per member, per month payments were made for 1,072 beneficiaries after they died. According to the August podcast, health officials told auditors that a plan, as of June 26, was to withhold $4 million from managed care companies in the next monthly payment.

Another issue reported in a June 2 podcast concerned $103.1 million dollars paid by the state for over 22,000 adult beneficiaries who “do not appear to have lived in Louisiana” during the per-member, per-month coverage period.”

As part of its response to the October audit, the Louisiana Department of Health has stated that it has reviewed the eligibility of individuals with no services and has already closed 27,176 cases. The department also agrees with auditor recommendations to step up analysis of data and hold managed care companies accountable for outreach.

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