Eric Eggers says Medicaid expansion was built with a flashing incentive to overenroll, under-audit, and send Washington the bill.
The Government Accountability Institute Vice President pointed to a new Paragon Health Institute estimate: 9.2 million people enrolled in Medicaid expansion as of 2024 did not qualify under federal rules, an 88% increase in five years.
“We’re paying for 90% of it, which is why it’s created this perverse incentive structure for states to put people in that category as opposed to the other category, where we’re only paying 60%,” Eggers told OAN.
Traditional Medicaid populations include vulnerable groups such as low-income seniors and disabled children. Eggers argued that the lower federal reimbursement rate for those recipients gives states a financial incentive to classify more people as eligible for expansion.
He also connected the enrollment failures to voter-roll disputes, arguing that states such as California and New York show the same resistance to verification in both systems.
“They don’t monitor, they don’t take care of these programs, they don’t audit it,” Eggers said.
Eggers said Biden-era rules made the problem worse by preventing states from removing suspected ineligible recipients.
“The head of CMS had a letter on December 5th, even after Donald Trump was elected, saying states are still not allowed to stop this,” he said.
Eggers tied that permissive climate to the vulnerabilities exposed by the Justice Department’s recent $6.5 billion healthcare-fraud takedown, which charged 455 defendants.
He noted that providers, not only recipients, allegedly exploited the system.
“It’s the people that these states are contracting with to provide Medicaid services who are committing the fraud,” Eggers said, describing the enforcement effort as “a sophisticated prosecution.”
“I’m optimistic this is just the tip of the iceberg.”
Eggers said the Trump administration has now reversed the incentives by conditioning federal money on cooperation, audits, and fraud-prevention documentation.
“Election integrity or welfare integrity, they’re leveraging the power of the purse,” he said.
That pressure, Eggers added, is already encouraging states to launch their own anti-fraud task forces.
The goal, he argued, is not to destroy Medicaid.
It’s to keep fraud from destroying Medicaid for the people who actually qualify.
Watch the clip above.
