More trouble on way for Medicaid, DSS boss says

Mar. 11, 2014 @ 07:02 PM

Another mix-up by the state government is likely to cause delays locally in deciding whether some Medicaid recipients can keep receiving subsidized health care, Social Services Director Michael Becketts said.

The problem could surface on April 1, showing up when affected recipients “go to get their prescriptions filled or go to doctors’ offices and they find out their Medicaid is no longer active,” he told county commissioners.

His warning came in a briefing that sought political intervention by the commissioners, and was at least partly successful.

Commissioners said they would take up the matter with state legislators, most likely in cooperation with a statewide lobbying group for county governments.

“This is essentially like a constant unfunded mandate,” Commissioner Ellen Reckhow said, alluding to the county’s having to shoulder the costs involved in cutting the extra red tape.

The issue comes because North Carolina delegates the grunt work involved in certifying the eligibility of Medicaid recipients to county social services agencies. And to prevent fraud, they have to do that for each recipient annually.

The federal Affordable Care Act introduced a new wrinkle by establishing a national-standard definition of income – in place of state-level rulemaking – for agencies to use in deciding whether a person makes too much money to qualify for subsidies.

But federal regulators offered states the chance to apply for an extension of the deadline for implementing the new definition. That, they said, would allow a smoother transition for aid recipients whose re-certifications were due this January, February or March.

North Carolina’s Department of Health and Human Services duly sought the extension, filing the necessary letter last August, getting an OK from the feds a month and a half later, and in late fall telling Medicaid recipients and county social services departments the issue had been addressed.

Problem was, the department broke a new state law that requires it to give a N.C. General Assembly oversight committee and the legislative staff 10 days’ notice before doing anything that might “expand or otherwise alter the scope of the Medicaid program.”

The required notice only went to legislators in January. And there, the request proved controversial.

That’s because the state has to cover the bill for any subsidies paid to recipients later found to have been ineligible for the program.

DHHS officials formally briefed the oversight panel on Feb. 11, key Republicans on it signaling that they objected to the potential expense.

And when analysts in the state budget office ran the numbers, “they estimated the cost of this waiver to be somewhere in the range of $20 million to $40 million,” Becketts said.

A week later, Gov. Pat McCrory’s administration passed the word to county level officials across the state that “that not only had the extension not been granted, it had not been requested,” Becketts said.

That “put us in a place where we now have to figure out what we have to do about all this additional work coming our way,” he said.

He added that his department normally does about 2,400 re-certifications a month, and that 95 percent of all re-certifications confirm a recipient’s continued eligibility.

Compounding matters, the department and its brethren around the state are struggling with the new database the state is using to administer the Medicaid program.

The database has proved both complex and unreliable, hurting productivity.

One of Becketts’ staffers told commissioners Monday that where it once took up to an hour and a half to process a Medicaid application, it now takes up to two hours just to do the initial data entry.

That prompted another Reckhow blast at the state.

“In this age of technology, you’re supposed to be able to work smarter and get things done quicker,” she said.

Becketts said he’s trying to blunt any short-term effects on recipients by working with the Duke University Health System and other private-sector players who bill Medicaid. Meanwhile, the Department of Social Services will shuffle staff and use temporary hires to bring more people to bear on the eligibility reviews.

But he fears some people will have to turn to hospital emergency rooms for care or do without their medication while the problem’s sorted out.

Monday’s presentation was in keeping with the wishes of some local social-services advocates for the director of the Durham department to be a vocal spokesman for its clients.

But it for the second time in recent months injected a nonpartisan administrator into what is a bitterly partisan debate.

Republicans in state government have signaled little interest in cooperating with the feds regarding the implementation of the Affordable Care Act, more colloquially known as “Obamacare.”

And the briefing materials DHHS submitted to the legislative oversight committee last month implied that state officials had focused more on the potential cost of subsidizing ineligible recipients than on making sure things go smoothly for those who are eligible.

It listed the matter of how counties would handle a surge in re-certifications as a question DHHS had yet to answer.

The head of DHHS, Health and Human Services Secretary Aldona Wos, among Democrats is the most controversial member of the McCrory administration. A physician and political fundraiser, she didn’t have any large-organization management experience before taking over the agency.