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Not much story here. States can't or don't want to track people outside the state, and it's tricky handling children of divorced parents who span states. There is little incentive for consumers to do their official duty by disenrolling, or for states to do their part and audit (it could decrease the federal funds they get to administer).

It also says much of the double counting was due to,

"The federal government’s emergency pandemic rules made it much harder for states to disenroll beneficiaries. The Journal’s analysis found that double payments nationwide increased from $814 million in 2019 to $2.1 billion in 2021. The emergency rules were revoked in 2023."

What's the total size of medicaid budget again?

We do need better systems to track, audit, and control but all of that is contrary the strong populist thirst for making disenrollments harder, and everything more inclusive.