The Office of the New York State Comptroller (OSC) has issued an audit report on the New York State Department of Health (NYSDOH) efforts to reduce Medicaid costs for people who are eligible for Medicare.  OSC found that NYSDOH had made little progress in making Medicare the primary payer and that this was unnecessarily costing Medicaid hundreds of millions of dollars.  You can access and read the OSC audit report below.

Department of Health – Reducing Medicaid Costs for Recipients Who Are Eligible for Medicare (Follow-Up) (2025-F-8)

Individuals who are eligible or appear eligible for Medicare are required to apply for Medicare as a condition of receiving Medicaid.  When Medicaid recipients are also enrolled in Medicare, Medicare becomes the primary payer and Medicaid the secondary, which allows for a significant cost avoidance for the Medicaid program.  A prior audit, issued in September 2023, found, from July 2016 through June 2021, 13,318 Medicaid recipients who appeared eligible for Medicare based on age were not enrolled in Medicare.  Medicaid could have potentially saved $294.4 million on behalf of these recipients for claims that could have been covered by Medicare as the primary payer.  At the time of follow-up, auditors found Department of Health officials made little progress in addressing the problems identified in the initial audit report, and additional actions are needed.  Of the initial report’s three audit recommendations, one was implemented, one was partially implemented, and one was not implemented.