Includes $21.8 million paid to managed care programs for dead enrollees.
3/6: Where the Money Goes
— A Guy on X Striving to be the VA Change Agent (@VaChangeAgent) February 15, 2026
56 cents of every Virginia Medicaid dollar flows to 6 managed care organizations as capitation payments. Another 14 cents goes to home and community-based waivers. Only 3.5 cents (after rebates) goes to pharmacy. Hospital supplemental payments ($3.3B)… pic.twitter.com/clI4mmJeWm
5/6: Red Flags
— A Guy on X Striving to be the VA Change Agent (@VaChangeAgent) February 15, 2026
CMS audits found $101M+ in MCO over-payments in Virginia. $21.8M was paid to managed care plans for dead enrollees. Some MCOs with 200K+ members referred fewer than 10 fraud cases per YEAR. And Virginia leaves ~$50M on the table annually in un-captured pharmacy… pic.twitter.com/snsXAqANqE
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