The state comptroller’s office found that the state Department of Health missed out on nearly half a billion dollars in savings because Medicaid patients weren’t enrolled in Medicare once they reached 65. The missed opportunity comes as the state health care budget is in for a reckoning due to cuts in federal funding.
The comptroller’s office followed up on a 2021 audit looking at Medicaid enrollment levels among seniors who were eligible for Medicare. New York’s eligibility system is supposed to automatically switch the initial burden of payment from Medicaid to Medicare once a patient turns 65 and is enrolled in the federal program, but the New York State of Health marketplace, a growing entry point for Medicaid, does not always guarantee the transfer. The automatic switch was paused in 2020 to prevent coverage lapses during the pandemic.
Once it resumed in 2023, DOH had county departments of social services resume checks on patients over 65 years old; however, the marketplace hadn’t fully resumed. The state comptroller’s office flagged 13,318 seniors as eligible for Medicare in 2023, but only 2,648 have been moved to Medicare in 2025…