BR.capitol.adv HS 001.JPG

The Louisiana State Capitol, Thursday, February 14, 2019, in downtown Baton Rouge, La.

Louisiana Legislative Auditor Daryl Purpera said Tuesday he would challenge an Edwards administration interpretation that state law forbids disclosing how many Medicaid enrollees could be making too much money to qualify for state/federal health insurance.

Purpera said his first step would be to seek an opinion from Attorney General Jeff Landry.

“We need to allow the Louisiana Legislative Auditor’s Office to have the data they need to do their job,” Purpera said.

Last year the Louisiana Department of Revenue provided analysis from 2016 income tax returns that indicated about 83,850 Medicaid enrollees could be making too much money to qualify for the government insurance. A request for similar data for 2017 was not nearly as responsive and yielded so little information that Purpera said he couldn’t calculate how many people might be improperly enrolled in the government-paid insurance program for children, the elderly and low income – approximately one-fourth of the state’s residents.

“I really think that the information provided earlier really shouldn’t have been provided,” state Revenue Department Secretary Kimberly Robinson said after appearing before the Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives.

The Revenue Department can provide statistical reports, such as how many tax filers claimed a particular income level. But what the Task Force sought was data that could determine which filers had claimed a certain income on tax returns and different income on Medicaid applications. That kind of analysis goes too far and opens her to criminal prosecution under state law La. R.S. 47:1508(B), Robinson said.

Besides the legal prohibition, Robinson noted that tax returns and Medicaid applications define income differently. The insurance applications set income levels based on how many dependents are in a household, but income tax returns have a far stricter definition for dependents that could change reported income levels. And that’s before considering that the working poor often hold hourly or seasonal jobs whose pay fluctuates.

About 37,000 Medicaid recipients were identified last month by a computer program newly installed by the state as possibly being ineligible for Medicaid coverage. They were given until March 29 to present information that could demonstrate their incomes are such that they could continue to be covered under the program.

"Anyone who can demonstrate eligibility stays," state Medicaid Director Jen Steele told the task force.

Though the federal government pays the lion’s share of the costs under the program, the bit that the state is responsible for is the single largest line item in the budget. Democratic Gov. John Bel Edwards sees as a major achievement his reversal of years of Republican refusals to expand the requirements and allow Medicaid to cover workers who had made too much money to qualify but too little to buy insurance on the private market.

More than 480,000 working poor and other nonelderly adults in Louisiana are enrolled in Medicaid through the expansion program. Adults ages 19 to 64 with incomes up to 138 percent of the federal poverty level — about $16,750 for a single adult or $28,680 for a family of three — are eligible for the coverage.

Purpera issued a report in November suggesting the state paid up $85 million over 20 months on providing health care coverage for people who didn’t qualify for the Medicaid program – largely because of the self-reporting standards for employment under the state’s previous eligibility system and worker errors. His auditors suggested more frequent checks using state wage data to ensure Medicaid recipients aren’t earning more than allowed to qualify. Pennsylvania, Wisconsin and other states do quarterly reviews to check eligibility against income data, the report says.

The monthly fee paid per ineligible recipient averaged $3,824, the report says.

Purpera’s audit was cited by two Republican congressmen – U.S. Sen. Ron Johnson, of Wisconsin, and Rep. Jim Jordan, of Ohio – in letter written last month to Centers for Medicare and Medicaid Services head Seema Verma, seeking a wide Medicaid misspending probe.

“If these improper payments are occurring in one state, it is logical to assume overpayments are occurring in other states,” the Republican congressmen wrote in the letter.

Louisiana U.S. Sen. John N. Kennedy, R-Madisonville, jumped into the fray Tuesday demanding LDH make public an accounting of any lost money from signing up ineligible people on Medicaid.

“The Edwards administration fought tooth and nail against legislation that would have allowed the Auditor’s Office to use tax returns to verify Medicaid recipients’ eligibility,” Kennedy said in a press release. “Medicaid is funded through the generosity of the American taxpayer. Every single penny in funding is sacred. That’s why I plan to ask CMS Administrator Seema Verma this week what can be done to recover the money that’s been lost to waste and incompetence.”


Follow Mark Ballard on Twitter, @MarkBallardCnb.