STATES CONFRONT MEDICAID COSTS WITH POLICY AND TECHNOLOGY
Across the United States, Medicaid has become a significant financial concern for state governments. What was once a safety net program is now consuming nearly a third of state budgets, forcing lawmakers to reckon with rising costs and inefficiencies. Medicaid expansion, prolonged enrollment protections, and pandemic-driven increases have pushed participation to historic highs, and with it, the cost to maintain the program has ballooned.
Now, facing mounting deficits and a shifting policy environment, states are acting decisively to get Medicaid spending under control.
IMPROPER PAYMENTS FUEL THE SPENDING SURGE
A significant source of Medicaid’s financial pressure lies in its high rate of improper payments. In fiscal year 2023 alone, the Centers for Medicare & Medicaid Services (CMS) reported over $50 billion in payments that shouldn't have happened, most tied to missing or unverifiable eligibility documentation.
Cumulatively, improper Medicaid payments have cost taxpayers over $543 billion in the past decade. These aren’t just accounting errors—they reflect deep operational flaws that make the program vulnerable to waste, abuse, and fraud.
POLICYMAKERS LAUNCH INTEGRITY INITIATIVES
In response, several states are deploying tough new policies to restore program integrity and weed out inefficiencies:
Indiana has ended self-attestation for Medicaid eligibility and now mandates ongoing cross-checks against federal and state databases. The state has also implemented quarterly reporting on fraud prevention and payment accuracy.
Texas has upgraded its eligibility verification systems to include IRS and third-party data checks, automating what were previously manual processes.
Florida and Missouri are conducting more frequent eligibility redeterminations and increasing scrutiny of Medicaid Managed Care Organizations (MCOs).
Arkansas and Georgia are utilizing data-driven redetermination strategies to streamline enrollment and prevent ongoing eligibility lapses.
States are no longer waiting for federal intervention. They’re proactively tightening controls to reduce errors, cut unnecessary costs, and better target assistance.
MODERN TECH: THE MISSING PIECE IN MEDICAID REFORM
While legislative reforms are a step in the right direction, they won’t succeed without modern infrastructure to support them. Technology is key to implementing oversight at scale, in real time.
That’s why more Medicaid plans are turning to platforms like ProTPL from Syrtis Solutions.
ProTPL is a real-time, automated system that identifies third-party liability (TPL) before Medicaid pays a claim—ensuring Medicaid acts as the payer of last resort. It enables state plans to:
Block improper payments before they happen, rather than recovering them later,
Automatically detect commercial coverage on pharmacy and medical claims,
Reduce manual eligibility checks to improve efficiency and accuracy.
Comply with federal cost avoidance and COB mandates with minimal effort.
ProTPL enables Medicaid plans to respond more quickly, operate more efficiently, and prevent losses at the source.
THE PATH FORWARD: STRONG POLICY + SMART TECHNOLOGY
As the fiscal burden of Medicaid grows heavier, one thing is clear: status quo systems won’t cut it. States that combine aggressive policy reform with smart, proven technology will be best positioned to rein in spending, reduce fraud, and protect coverage for the people who need it most.
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