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Published: Tuesday, January 14, 2020 @ 4:41 PM
— The director of the Ohio Mediciaid program said Gov. Mike DeWine’s administration inherited a “mess” from the Kasich administration, leading to bad audits, severe technical issues and backlogs that left people waiting for benefits.
Ohio Department of Medicaid Director Maureen Corcoran, in a 2019 year-end summary memo to the governor, described what she called a series of inherited issues the department confronted during its first year under the DeWine administration.
This includes significant technical challenges with the $1.2 billion Ohio Benefits enrollment system, leading to problems like incorrectly dropped applications and delays in coverage. The system is what determines the eligibility for about 140,000 Montgomery County residents covered by the health insurance program, which covers the poor and some people with disabilities.
Jim Lynch, a spokesman for the former Kasich administration, said when the previous governor came into office, they had an $8 billion shortfall “due in no small part to unsustainable growth in Medicaid.”
“So, we got to work to reform the program, cut the growth from nine percent to below four percent, and covered 700,000 more people. The state’s leadership now has the opportunity to build on eight years of progress, further fine-tune a complex program, and reassure Ohioans that critical health care services will be there when they need them,” Lynch stated.
The 13-page memo from Corcoran paints a wide ranging picture of significant time and resources spent resolving problems from audits, correcting technical problems and overhauling procedure. Corcoran said her team has since instituted improvements to operations.
“Ohio Medicaid has come a long way in the past 12 months to overcome systemic challenges, organizational shortcomings, and program vulnerabilities that plagued the department for years,” Corcoran said.
The report revealed years of technical issues with the overhaul of the Ohio Benefits system, which cost $1.2 billion to date. The new system was initiated in 2013, with the help of federal funds, to comply with the Affordable Care Act. It was supposed to be a simplified online application process that replaced a 30-year-old system, which had its own problems.
It was highlighted as a priority for the Kasich administration.
However, Corcoran said the department had so many problems with the data that they didn’t feel like they could trust the information they were getting, which they needed to make make multi-billion dollar spending decisions.
Ohio had a payment error rate of 44.38% for the Medicaid population and 55.41% for the Children’s Health Insurance Program population for fiscal year 2018. Of the 17 states sampled in the audit cycle, Ohio ranked last for Medicaid and second last for CHIP. She said Ohio’s high payment error rate shows degree to which the basic system functioning was ignored and the magnitude of potential fiscal penalties for the state of Ohio for years to come.
The technical problems led to 1,765 “work arounds” that require staff to go through multiple time-consuming manual steps to complete routine tasks.
“This additional work would not be necessary if the system were properly function,” Corcoran said.
A few examples of the problems with the Ohio Benefits system include:
• County workers are reporting that the Ohio Benefits system is causing some individuals applications for benefits to disappear.
• It sometimes links newborns to people who are not their actual parents, including in one instance a baby was linked to an 11-year-old child who was labeled as the parent.
• The system lets a person be entered more than once, which could mean the state paying an insurance plan twice for the same person.
• They system is not tracing whether it is properly submitting all required IRS forms.
• The system gives incorrect dates for renewals, which can cause late renewals or in some cases fail to trigger a renewal at all.
Corcoran said the defects are also compromising the privacy of people covered by Medicaid. In 2019, 22 separate privacy incidents have occurred stemming from network defects such as improperly linked member portals. The privacy incidents have affected more than 700 Medicaid members, she said, and Medicaid staff have then had to spend hundreds of hours responding and preparing federal reports and notices to the people affected.
Giving an example, Corcoran said members have a portal where they can look at their information online and there was a situation where a person’s information was entered into a different person’s file.
She said the team is working to fix the problems. They hold weekly meetings with federal regulators to discuss their progress making corrective action. They also added 25 employees for trouble shooting and technical assistance.
As of today, she said the backlog is reduced by about 70%.
“The piece I’m most concerned about is that people get access to the benefits they are entitled to,” said John Corlett, former Medicaid director under then Gov. Ted Strickland, now head of The Center for Community Solutions. “These are people that are in need and they deserve to get their cases treated accurately and efficiently and rapidly.”
Montgomery County’s Family Assistance Division had announced in December that the team had nearly eliminated a significant Medicaid backlog.