Fact check: Are there millions of ineligible people on Medicaid?

1. Summary of the results

The claim about "millions of ineligible people" on Medicaid is not supported by concrete evidence. While Medicaid serves approximately 74 million people ^[1], the actual improper payment rate in 2024 was 5.09%, amounting to $31.1 billion, with most issues stemming from documentation errors rather than fraud ^[2]. Claims about 8 million ineligible recipients, made by HHS Secretary Robert F. Kennedy Jr., are unsubstantiated and appear to be based on a misinterpretation of Congressional Budget Office estimates about potential coverage losses ^[3].

2. Missing context/alternative viewpoints

Several important contextual factors need consideration:

• The vast majority of fraud is committed by providers, not beneficiaries. Only 2% of fraud convictions and 0.1% of recoveries relate to beneficiary fraud ^[2]
• Recent examples of provider fraud include:
• Pharmacy owners billing for non-dispensed medications ($13 million case) ^[4]
• Mental health business fraud in Arizona ($60 million case) affecting Native American communities ^[5]
• During the COVID-19 pandemic, enrollment increases were legitimate, and most current removals from Medicaid rolls are due to procedural issues rather than ineligibility ^[6]
• The figure of 1.4 million people often cited actually refers to state-funded health programs, not Medicaid ^[7]

3. Potential misinformation/bias in the original statement

The original question appears to stem from politically motivated narratives that overstate the scale of Medicaid fraud. Several entities benefit from promoting this narrative:

• Political actors seeking to justify Medicaid funding cuts or program restrictions
• Media outlets seeking sensational headlines about government waste
• Private insurance companies that might benefit from reduced public healthcare coverage

The reality is that Medicaid has a structured eligibility process ^[1], and while fraud exists, it's primarily a provider-side issue rather than beneficiary fraud ^[2]. Claims about massive numbers of ineligible recipients often conflate procedural issues, documentation errors, and legitimate pandemic-related enrollment increases with actual fraud ^[6].