As the 119th Congress seeks to reduce government spending through reconciliation, talk of Medicaid reductions has raised concerns about vulnerable populations losing Medicaid coverage. But simply following the law and paying only for what Medicaid allows would save hundreds of billions of dollars without ending coverage for any of Medicaid’s intended recipients.

According to official reports, the government issued $543 billion in improper Medicaid payments from 2015 to 2024. But that’s only what the government measured.

Based on the few years that the government performed full audits, I coauthored a report with Paragon Health Institute President Brian Blase that estimated that the true amount of improper payments is twice that, totaling roughly $1.1 trillion over the last decade. That’s a whopping $8,200 per U.S. household.

The primary reason for the discrepancy is that the Obama and Biden administrations excluded eligibility checks in their audits of improper payments in Medicaid. But eligibility errors and failures to properly assess eligibility prior to enrollment are the biggest sources of improper payments.

Since Medicaid is a means-tested welfare program and includes different federal reimbursement rates based on enrollees’ eligibility status, checking eligibility is........

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