Coordination of Benefits: An Overlooked Pillar of Medicaid Programs


Medicaid is a vital healthcare safety net in the U.S., with $824 billion in spending in 2022. One important but lesser-known aspect is the coordination of benefits, which ensures efficient management of funding sources and prevents overutilization of services. This practice also maximizes financial resources, promotes fair distribution of resources, and mitigates fraud and abuse. Medicaid operates under a unique financing structure, with the federal government providing 69% of funding and states 31%. Many Medicaid programs have adopted liability recovery platforms to improve coordination of benefits. Ultimately, coordination of benefits is crucial for the financial sustainability of Medicaid and enhancing healthcare access for beneficiaries.

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