Welfare moms running down the streets of Louisiana cities waving checks pilfered from Medicaid could be the iconic image of this 25-day special session of the Louisiana Legislature.
As the session reaches the halfway point — by law it must end March 9 — reining in Medicaid fraud is spoken of frequently, as if repetition validates a fabled cache of treasure that would fill the $900 million gap between funds available and promises made.
“I know the legislators are using this as a way to help fix the budget, but I struggle with that,” said Jeff Reynolds, who, as undersecretary of the state Department of Health and Hospitals for the past few years, is this state’s foremost expert on Medicaid.
It’s not that there’s no fraud, waste or abuse in Medicaid. It is the largest program in state government, serving about a fourth of the state’s 4.6 million residents and accounting for about a third of state spending. But nobody really knows how much fraud exists.
“I can’t refer to a report and point to a number and say this is the amount,” Reynolds said.
Louisiana Legislative Auditor Daryl Purpera agrees but notes that during a meeting last fall, Gene L. Dodaro, the comptroller general of the United States, told him that the U.S. Government Accountability Office had estimated that nationally, 5.8 percent of the Medicaid and Medicare claims were subject to fraud, waste or abuse.
“I started diddling on a napkin. OK, we have roughly about $8 billion in Medicaid in Louisiana,” Purpera said last week. “We’re talking about $480 million.”
And the Centers for Medicare & Medicaid Service, the federal agency that controls the health care program for the poor, suspects that Louisiana’s number is closer to 10 percent, given the past budget cuts to DHH. “So, now it’s about $800 million,” Purpera said.
The GAO on Tuesday released a report calling on the federal agency to upgrade its vetting processes for those enrolling in Medicaid around the country. Medicaid fees are paid monthly based on a complex formula based on how many people were treated — including those whose lack of eligibility was uncovered, Purpera said.
This where various political narratives become entangled.
There’s the economic stimulus rhetoric about how smaller government spurs private sector investment, which in turn provides jobs and pumps up the economy, thereby lifting incomes in a state where nearly half the population is either poverty-stricken or hovers near that level of income.
Then there’s the GOP opposition to Democratic President Barack Obama’s signature Affordable Care Act, a key component of which is expanding the rolls of Medicaid to provide access to the program for people who make just a little too much to qualify.
Eight years ago, DHH employed about 550 staffers charged with ensuring that the million or so Louisiana residents enrolled in Medicaid met the eligibility requirements year after year. Since then, about 250 of those workers were laid off. The hoped-for economic boom never materialized. Now Medicaid has 1.4 million clients but only 300 DHH employees checking eligibility qualifications.
Assuming evil intent isn’t really fair.
Chances are more than likely that most of the people enrolled in Medicaid have little clue whether they really are eligible. The multi-step qualification process is a complex formula that includes weighing the source of this income against that asset value, adjusted for where you live and the size of your family.
In July — after years of GOP opposition — the Medicaid rolls will be expanded under the Affordable Care Act, bringing the numbers up to about 1.8 million, maybe even 2 million people. Almost the first words out of Rebekah Gee’s mouth after her appointment last month to lead DHH was the need to hire 248 new employees to scrutinize eligibility of Medicaid enrollees.
Not so fast, Louisiana House Appropriations Committee Chairman Cameron Henry, R-Metairie, said last week. He told the Chamber of Commerce of East Baton Rouge Parish, a group of conservative small business owners, that he opposed the hiring of new employees at DHH. It just didn’t look good in the wake of the massive cuts to other government services and the likelihood of tax increases brought on by the budget crisis.
What legislators did agree is a bill to fund and legitimize embedding a team of auditors at DHH to oversee transactions in real time — rather than wait until the end of the year to review the records.
The House approved the legislation on Friday and now goes to the Senate. Reynolds said DHH welcomes the help and is arranging for office space.
Mark Ballard is editor of The Advocate Capitol news bureau. His email address is firstname.lastname@example.org and is on Twitter, @MarkBallardCNB. For more coverage of government and politics, follow our Politics Blog at http://blogs.theadvocate.com/politicsblog/.