For years, I’ve pleaded with Medicaid administrators to help control the program’s ballooning costs by embracing a little common sense. I’ve complained about Medicaid patients treating expensive emergency rooms like primary care clinics. I’ve asked the Louisiana Department of Health to encourage Medicaid recipients to skip the ambulance ride and walk to the drugstore if they need a pregnancy test or treatment for acne or the sniffles.
It turns out that I should also have been railing at the administrators of Louisiana’s Medicaid program for a waste of taxpayer dollars that is breathtaking in its scope. Reckless, runaway spending like this is why I introduced the Income Verification Act of 2018 in Congress.
My bill is pretty simple. In fact, it’s just common sense. States will be required to use federal tax information to verify income eligibility for Medicaid, Temporary Assistance for Needy Families (welfare) and SNAP (food stamps). Some states are doing this already. Too many states aren’t. They’re handing out taxpayer funding like it’s Monopoly money without checking to see if you live on Boardwalk or Baltic Avenue.
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The first indication that something was alarmingly amiss came when the Louisiana Legislative Auditor’s Office looked at the state’s supervision of the private companies that manage the medical treatment of more than a million Medicaid patients.
The state pays the companies — called managed care organizations — a monthly premium to act as a liaison between health care providers and Medicaid patients. The managed care organizations function as a private insurance company does. All the state has to do is make sure of two things: that the paperwork is handled correctly and that patients are eligible for Medicaid. Failure at either one of those things would be like turning on the garden hose and going to bed. Millions — if not billions — of taxpayer dollars would gush needlessly into the dirt. Unfortunately, that’s exactly what’s happened.
Auditors found a litany of problems in how the Louisiana Department of Health oversees managed care organizations. Lax oversight and shoddy paperwork within LDH means we have no handle on Medicaid payments. Basically, we just blindly paid bills without checking for errors. Given the size of the program, that’s a huge problem.
More problems materialized in subsequent reviews of health department records.
A 35-page Legislative Auditor report released in November delved into the eligibility of Louisiana’s Medicaid expansion enrollees. The entire goal of Gov. John Bel Edwards’ Medicaid expansion was to open the program to people who were previously excluded because of their income levels. Supposedly, they made just a little too much money to qualify for taxpayer-funded health care.
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Already struggling with a Medicaid program that consumes a hefty chunk of the state budget, the state made the program even bigger in 2016 by adding 490,000 people to the rolls.
Not all of those people actually qualified. The Louisiana Legislative Auditor’s Office found that the state did a poor job of confirming enrollees’ income eligibility even though the whole basis for Medicaid expansion is income. In fact, the state may have spent up to $85 million on patients who were ineligible for Medicaid because they made too much money to qualify.
December brought a third report by the auditor’s office, and the conclusion was just as damning as the rest. Auditors randomly looked at 60 Medicaid expansion recipients. Of those 60, 8 percent didn’t even qualify yet received $60,586 in health care benefits courtesy of the taxpayers. The problem, yet again, was that the state didn’t do simple income verifications.
Sadly, Louisiana isn’t alone in a haphazard approach to the Medicaid program. That’s alarming in a program that consumes nearly 10 percent of the federal budget, not including the millions of dollars that states kick in. Louisiana alone spends nearly 40 percent of its annual budget on Medicaid.
What’s even more alarming is that Medicaid runs on fuel provided by the American taxpayer. Every misspent dollar is a dollar less for American families. Every ineligible Medicaid patient is a drain on those families’ dreams for their retirements and kids’ college educations. Every ineligible Medicaid patient is a teacher pay raise that can’t be given. Enough is enough.
Louisiana finally saw the light. The embarrassing audit reports and my legislation convinced the state to start using federal income tax records for determining Medicaid applicants’ eligibility.
I’m moving forward with my bill so Louisiana can’t double back and other states fall in line. Given the mess at LDH, I’m calling on Edwards to embrace my legislation. While he’s at it, he should expand income verification to food stamps and welfare. Enough taxpayer dollars have been wasted.
John Neely Kennedy is a U.S. senator from Louisiana.