Gov. Roy Cooper has been talking for months about Medicaid expansion. The state auditor sent him, and all of us for that matter, an alarming message Monday.
Our system is in trouble, and it is costing us. The Department of Health and Human Services, led by Cooper appointee Mandy Cohen, has failed to monitor state policies and best practices with seven tax-supported local management entities and managed care organizations.
The audit found $100 million in Medicaid errors.
Cohen agreed with the conclusions and recommendations in a letter attached to the report from Beth Woods’ office.
If DHHS can’t ensure services being provided, that the costs with them were reasonable, and that the performance standards were met, why would we expand?
Put another way, consider an example of Company X in Elizabethtown. It believes it should expand, and is ready to make it happen. Then it finds out there have been mistakes — big ones, at that, leading to costs of more than $100 million.
Would it expand before figuring out why there’s been a $100 million loss, before risking multiplying that $100 million setback? You betcha they would fix the problem first, then decide on expanding.
Thirty-six other states have either expanded Medicaid or its voters have passed ballot initiatives.
Cooper has allies, to include the educators who recently marched in Raleigh. That group came seeking changes that are estimated to cost $6.2 billion.
DHHS has got to get a handle on things.
It didn’t get encounter data reports based on client visits. These help develop the payment rates and measure the quality of services by the local management entities and managed care organizations, referred to often as LME/MCOs.
That means, the Society of Actuaries would say, it didn’t get “the single most important analytical tool for health plans and health programs.”
DHHS was without incident reports showing when providers failed to ensure adequate staff was available to provide services.
The annual budgets of the LME/MCOs were not known. DHHS had no clue where it stood with revenues and costs.
If third party companies and providers were being used, DHHS didn’t know about it. The LME/MCOs can use them, including to push profits past allowable state guidelines.
We don’t know how DHHS did with grievances. In 24 of 26 performance evaluations, there was no documentation of consistent handling.
We’ve heard a lot about mental health and substance use. DHHS should be sure patients get follow-up visits within seven days of discharge for treatment, but having personnel be sure that happens didn’t result in corrective action plans or penalties.
It’s a mess.
Opinions run strong on Medicaid and its possible expansion.
But we shouldn’t be taking a step in that direction without first fixing what we have now. The auditor’s report simply can’t be ignored.