State tries again to fix Medicaid problem

Mar. 15, 2014 @ 08:41 PM

North Carolina’s social services director says state officials are trying to reduce the workload at the county level when it comes time to decide whether thousands of people will remain eligible for Medicaid.
The state has asked federal regulators for a new waiver that for the time being would let county departments of social services like Durham’s handle most Medicaid recertifications using the rules and software they’re most familiar with, said Wayne Black.
State officials understand it’s “going to be a very difficult hurdle” for county departments if they have to adapt to new eligibility rules at the same time they’re dealing with new software, Black said.
“We want to do it right,” he said, explaining the waiver request is also trying to buy time for the N.C. Department of Health and Human Services to help case workers at the county level learn the ins and outs of the state’s new records database.
Black’s comments were in response to a Herald-Sun report detailing the worries Durham Social Services Director Michael Becketts has about the recertification process, in particular its effects on people who came due in the first quarter of the year.
Becketts warned County Commissioners on Monday that his staff faces a doubling of its normal Medicaid casework, and that some recipients because of processing delays could find their health care aid suspended as of April 1.
The problem comes because the federal Affordable Care Act nationalized the income-qualification standards for Medicaid eligibility, in practice loosening them as of Jan. 1.
Without a waiver, the new standards have to be used in the recertification process. And for county level caseworkers, that means working with a new database, N.C. FAST, that’s still in the early-adopter phase.
DHHS asked federal regulators for a waiver last summer, and got it.
But it had to pull back because it’d neglected to clear the move with state legislators, who worried the state would have to cover the bill for any aid that had gone to recipients later found to have been ineligible.
Becketts told commissioners estimates indicated the state could’ve been on the hook for $20 million to $40 million in extra costs.
Legislators were briefed on the new waiver request on Wednesday, and appear not to have voiced any objections.
It would allow county caseworkers to first evaluate Medicaid recipients’ eligibility using the old income standards, which they can judge without having to punch application information into the new database, Black said.
Those that quality under the old standard would continue receiving aid.
For those that don’t, the caseworker would then have to apply the new rules, which will mean working with N.C. FAST because the previous software doesn’t have those rules coded into it.
But the initial use of the old rules and old software should “greatly minimize the number of cases that would have to be entered into N.C. FAST and worked in N.C. FAST,” at least until a full-on transition to the new system later this year, Black said.
The latest waiver request asked permission to continue use of “the legacy system” until December.
Black said DHHS has been using 160 temporary workers to clear up bottlenecks and train caseworkers at the county level on the use of N.C. FAST. That will continue, in parallel with work to modify the system to improve its usability.
The application shouldn’t present the same cost issue as the first one, he said.
Dollar-wise, the impact to the state should be “very, very minimal,” Black said.
“Our take is there would be folks not eligible under traditional [income limits] that might be under [the new ones], but we don’t think there’s many the other way around.
Federal approval of the new waiver request remains pending, but DHHS officials are optimistic about getting it because regulators have approved a similar application from at least one other state.
Black said he understands the worries Becketts has about the issue, and appreciates him and other county level directors who are “being proactive” in dealing with it.
He alluded to the problems state and county officials had last year in processing applications for food stamps, which sparked a run on food-pantry services in many communities.
Medicaid is even more critical because there are fewer backups for it, he said.
“If you’ve got a child that needs a prescription filled or a surgery or some type of therapy, that can’t wait and there’s no equivalent of a food pantry out there,” said Black, who led social services departments in three counties because joining DHHS last year.