The official kickoff of a new computer system in state government may not seem like the most dramatic story to come out of Baton Rouge, but it is an important step forward in one of the biggest programs in the budget.
At a cost of $71 million, not small change, the Louisiana Department of Health has installed an overhaul of the ancient — in computer terms — enrollment system for the giant Medicaid program.
Medicaid’s federal-state insurance program for poor families is the largest item in the state budget and was expanded under Gov. John Bel Edwards’ decision to adopt the provisions of the U.S. Affordable Care Act, aka Obamacare. That added some 481,000 recipients to the rolls.
We think that was a good move. Louisiana’s population includes many people dependent on low-paying and often sporadic jobs. Health insurance coverage is vital to not only the finances of those families but the ability of people to work in the first place.
But with new and old enrollments, an early 1990s computer system was simply inadequate to police the rules for Medicaid. As with many Medicaid administrative costs, the expense of the new computers is partly financed by the state but is mostly paid for with federal funds. But it is the state government that is responsible for spending Medicaid money, although private insurers have been contractors for service delivery since the administration of former Gov. Bobby Jindal.
The Legislative Auditor’s Office has audited Medicaid at least nine times since Medicaid expansion. According to the most recent report, LDH may have allowed up to $85 million to be spent on ineligible people during a 20-month period.
That number was extrapolated from a small sample, but given what LDH had to work with, and the large numbers of people enrolled in Medicaid, it is not that surprising. Nor is it at all unwarranted for the auditor's office to focus on such a big program.
"Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately," auditor Daryl Purpera concluded in his overview, which was presented to legislators last month.
Much was made of this audit by Edwards’ critics, but the reality is that the computer upgrade, taking years to achieve, was nearly complete and is exactly the sort of thing that we have called for in state government for years — long before Edwards took office.
Many large organizations invest too little in technology, but government in general and Louisiana in particular is among the worst. “Legacy” data is a far-reaching administrative problem. We welcome the new system for Medicaid enrollment, but there is more to be done on the technology front in state government.
Making quick political talking points is one thing. Doing the long-term work of making government more efficient is much harder.