In a survey of 39 states, the Government Accountability Office found that in as many as 27 states officials could not verify whether Medicaid beneficiaries also had private coverage over some portion of the year. Some insurers do not provide states with access to their customer information, citing privacy laws; and while Medicaid is supposed to only be the coverage of last resort, officials suspect that some people use the system because the out-of-pocket expenses are less than with private insurance.

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