Medicaid Enrollment Under Fire—But the Facts Tell a Different Story

More than 70 million Americans rely on Medicaid for their health coverage. For many, it’s not just a program—it’s the difference between access to necessary care and going without. So when high-profile media outlets like The Wall Street Journal question the integrity of Medicaid enrollment, it’s not just misleading—it’s potentially damaging to the public understanding of how Medicaid truly works.

A recent Journal piece has cast doubts on the accuracy and accountability of Medicaid enrollment, suggesting widespread issues with concurrent coverage and waste. But this narrative glosses over the reality on the ground and ignores the safeguards built into the program to ensure its reliability and fiscal responsibility.

Let’s be clear: Medicaid is working.

According to the Centers for Medicare & Medicaid Services, concurrent enrollment—when an individual is enrolled in Medicaid in more than one state at the same time—is exceedingly rare, affecting less than 0.5% of enrollees. That’s a fraction of a fraction, and it’s often temporary and tied to life circumstances far outside of the enrollees’ control. People moving between states, experiencing homelessness, working seasonal jobs, or facing chronic illness may have their eligibility and coverage periods briefly overlap. That’s not fraud. That’s a reflection of a complex healthcare landscape and real human experiences.

What’s more, states and Medicaid managed care organizations (MCOs) already have mechanisms in place to prevent and resolve these rare occurrences. Payment audits, rate setting based on real-time enrollment data, and contractual recoupment clauses ensure that Medicaid plans aren’t profiting from short-term duplicate coverage. And if concurrent enrollment is discovered, states have the tools to recover funds and maintain financial integrity.

Critics also ignore the impact of the COVID-19 pandemic on Medicaid enrollment trends. From 2019 to 2021, the federal government paused routine eligibility redeterminations to ensure continuity of care during the public health emergency. That pause—combined with significant population movement—led to a temporary uptick in coverage transitions. But those transitions were not evidence of mismanagement; they were the result of deliberate federal policy designed to protect vulnerable communities during a crisis.

Meanwhile, Medicaid plans are bound by federal medical loss ratio (MLR) rules, which cap administrative costs and ensure that most of the dollars go directly toward patient care. These requirements mean states and taxpayers are getting real value from Medicaid—and that health plans have little incentive to game the system.

The Journal’s narrative fails to acknowledge a fundamental truth: Medicaid is not a static program—it’s a dynamic, responsive system that evolves with the needs of the people it serves. It’s overseen through robust partnerships between states, managed care organizations, and federal agencies, all of whom are deeply invested in maintaining its integrity.

Policymakers and the public deserve accurate reporting on one of the most essential components of America’s healthcare safety net. Medicaid is not perfect—but it is effective, well-regulated, and absolutely vital.

In today’s media environment, it’s easy to grab headlines by spotlighting statistical outliers. But responsible journalism—and responsible policy—requires understanding the context behind the numbers. For the more than 70 million Americans who depend on Medicaid, that context isn’t just important—it’s life-changing.