Capitol Fax.com - Your Illinois News Radar

Behind the he said, she said on Medicaid reform

Posted in:

Illinois

* The Republican leaders held a press conference yesterday to express their frustration with the pace of Medicaid reform…

Some Republican members of the Illinois General Assembly accused Gov. Pat Quinn’s administration Monday of dragging its feet on making cost-saving changes to the state’s Medicaid program.

In particular, they said the administration has been slow to begin reviewing Medicaid rolls to eliminate people who do not qualify for benefits.

“To date, they have not even started the process,” said House Republican Leader Tom Cross of Oswego. “We’re now told it won’t be until January of next year that they will start the implementation of ‘scrubbing.’ To put this off until January is unacceptable.”

Well, actually, they have started the process. The law requires the state to award a contract to scrub the Medicaid rolls within the budget year’s first 90 days. The state did it in a little over 70 days. The contractor, Maximus, Inc., will need some time to set up the system to get the work done right.

* The Republicans suggested a political motive…

Cross even suggested Quinn’s delays could be political, putting off the cuts until after the Nov. 6 election. Quinn’s office sharply denied that idea.

“What else could be the reason?” Cross said.

The Quinn administration could’ve waited another three weeks until the 90-day time limit expired to sign the contract, so I’m not sure there’s a huge political conspiracy here.

* Even so, the Republicans are not satisfied…

Maximus will review pay stubs, addresses and other information for current recipients and for people who are signing up for benefits to make sure they live in Illinois and don’t exceed income limits.

It’s not clear how many people will be kicked off the Medicaid roles, but lawmakers and the governor say the change could save $350 million.

Republicans, who have made combating Medicaid fraud a key component in their party platform, complained Monday that the administration isn’t moving fast enough.

They said Maximus should not wait until January to implement the program.

“To put this off until January of 2013 is unacceptable,” said House Minority Leader Tom Cross, R-Oswego.

Republicans say the delay could result in the state not saving as much as money as predicted, which could force lawmakers to have to return to Springfield to make further cuts to the budget.

“There’s no excuse. This was passed last spring,” said Senate Minority Leader Christine Radogno, R-Lemont. “This is something that is not difficult to do.”

Again, the administration signed a contract in a little over 70 days, when the law that the Republicans helped negotiate allowed for 90 days.

And the company has to open a call center, hire workers, let out subcontracts and train state employees to use the new system. That takes time.

The Republicans do make a very valid point, however, that the longer this takes to implement, the fewer savings will be realized by the end of the fiscal year, unless Maximus really kicks it into high gear.

* But GOP claims about the amount of money that could be saved by tightening up the roles have always been a bit on the bloated side…

“There is some research that shows people don’t [game] the system as much as is implied by some. Some of the legislators claimed 20 percent of people are income-ineligible because we haven’t verified their income. I think that is a very high number and not likely,” says Robert Kaestner, a professor at the University of Illinois Chicago who is affiliated with the University of Illinois’ Institute of Government and Public Affairs.

* The company does get results. For instance…

Our Illinois early intervention project produced a $24.5 million net increase in child support collections in the three years through June 30, 2011 – $25.63 collected for each dollar spent

* But there are concerns about outsourcing this sort of work…

Another troubling aspect to this company is that the increase of poverty and pressures to downsize government actually makes for good business. They say as much in their SEC report: “Our core health and human services business has benefited from steady demand over the last five years. We have not experienced any material adverse change in demand as a result of government budgetary pressures. We believe the critical nature of our services in helping governments provide and administer important safety net programs in the U.S., such as Medicaid, welfare-to-work and CHIP, to the most vulnerable populations helps insulate our services from significant downward pressure, particularly during an economic downturn.”

Recently the Project on Government Oversight released a report concluding that the federal government actually pays billions more to hire private contractors than what it would pay current public sector workers to perform comparable work; a Heritage Foundation reports states the opposite. Analyses supporting both sides of this debate are plentiful, but there is little disagreement that over the past several decades, privatization of government services has increased dramatically and hundreds of billions of dollars are spent outsourcing public services.

* The state, however, was clearly in over its collective head on this task…

For more than a year, Republicans have charged that the Quinn administration has not pushed hard enough to implement money-saving reforms targeting ineligible Medicaid recipients. The administration has contended that one attempt to require more paperwork from recipients to prove their eligibility and fight fraud was blocked by the Obama administration because states were not supposed to increase requirements under the president’s signature health care program, the Affordable Care Act.

The state pressed ahead by using electronic methods of matching data, such as with addresses from the Illinois secretary of state’s office, that the federal government deemed more acceptable. Yet the agency said it needed more sophisticated tracking help, leading to the Maximus contract.

* Also, just as an FYI, a longtime member of the Maximus board of directors is former GOP Gov. Jim Thompson.

posted by Rich Miller
Tuesday, Sep 18, 12 @ 10:30 am

Comments

I watched their little dog and pony show yesterday. They were quoting the number of ineligible people on the rolls. If they know who they are perhaps they could do the work since they believe it is as simple as flipping a switch. I’m sick of the continual bashing by the Republican “leaders” (and I use that term loosely), especially when they have no reason to spew such nonsense. The state signed the contract BEFORE the deadline. The program is being put in place. How about you work on something more productive instead of once again making yourselves look like idiots and grandstanding in front of the press on a non-issue.

Comment by Demoralized Tuesday, Sep 18, 12 @ 10:38 am
Many of the folks found ineligible under current guidelines will very probably be eligible for Medicaid or subsidies under the ACA beginning January 2014. So we are paying a good chunk money to take them off Medicaid (and health care)for a few months.

Comment by cassandra Tuesday, Sep 18, 12 @ 10:58 am
=== The Republicans do make a very valid point, however, that the longer this takes to implement, the fewer savings will be realized by the end of the fiscal year ===

I’m not sure that’s true. I believe either HFS or the AG has the authority to require providers to return the money for anyone who was deemed ineligible at the time of care.

Comment by Yellow Dog Democrat Tuesday, Sep 18, 12 @ 11:01 am
==”Republicans have charged that the Quinn administration has not pushed hard enough to implement money-saving reforms”==

Does this mean that GOPer’s in the GA are ready to support refinancing of Illinois pension debt at historically low rates to realize savings now?

Comment by Crime Fighter Tuesday, Sep 18, 12 @ 11:01 am
And at the same time, AFSCME is screaming about the contract and telling their members they are going to lose their jobs because of the contract with Maximus.

Comment by Give Me A Break Tuesday, Sep 18, 12 @ 11:07 am
Big Jim’s associates and partners seem to get an awful lot of big fees and contracts from the state.

Comment by walkinfool Tuesday, Sep 18, 12 @ 11:12 am
Quick question - Why are pay stubs used as sufficient income verification? Why aren’t income tax returns also required? Anyone working more than one job could easily “game” the system by producing stubs only for the first job. Anyone working should have filed an income tax return.

Comment by Income Verification? Tuesday, Sep 18, 12 @ 11:14 am
@Income Verification:

Because tax returns tell you whether or not someone qualified last year, not whether or not they qualify today.

Comment by Yellow Dog Democrat Tuesday, Sep 18, 12 @ 11:19 am
Having to deal with local government outsourcing applications from both the provider side and on a recipient basis, a few observations.

1) Ever provider has issues - you just don’t always know what they are. A outsourcing business entity may be great at a number of areas, but on unfamiliar territory, not so much. If you are having to go that route, imagine having these folks as employees and ask yourself if they can do the job. If the answer is ‘No’, step back and reconsider.

2) It’s all about allocation of scarce resources (like current knowledgeable employees, time constraints, other responsibilities, digital processing systems, etc.). Just because you can do something in house, doesn’t necessarily mean you should. It’s all about ‘Opportunity Cost’ - Think of it in terms of “Giving up something to get something”. Take the personalities out of it.

3) A tip off is the introduction and delivery of technology as part of the outsourcing. If you see the outside vendor coming in with customized digital applications to allow them to perform the job, that tends to be a positive sign. If they want you / your IT staff to do the customization or pay for all of it (additionally), IMMEDIATELY step back and re-assess the situation. It’s not an automatic yea or nay, because sometimes your custom requirements are stupid requests.

4) Program orientation conflicts. It’s quite common for a department to be running multiple program ‘line’ operations, where the requirements and administration of one ‘line’ program end up causing conflicts with the requirements and administration of a different ‘line’ program in the same department (they overlap in a bad way).

Ran up against this recently, where within one program there are two different types of activities, one of which almost always occurs outside of the normal 8-5 M-F working hours (about 16-17% of the workload). But everybody has 40 hour weeks (union shop), there’s zero OT budget (cutbacks), so it’s always comp time. But the comp time has to be taken within the following 4 weeks, and cannot be rolled over into the next budget year.

So, the work schedules are always a giant mess, the primary services program (about 84/83% of the work) is always behind because the same people are having to use their accumulated comp time or lose it. And it’s getting worse. And vacations, medical leave, or worse, job vacancies just make things even worse.

There’s a hiring freeze - no new jobs - flat out isn’t happening. Insufficient money is available, anyway.

Best bet is to outsource the secondary work (the 16-17% workload) to a qualified outside vendor. Won’t happen - union won’t allow it. Their stock answer is “Add more people” or “Pay overtime”. The governing board isn’t having any of that - not in this economic environment, where those answers would require a substantial property tax increase.

No jobs would be lost.

Unsolvable. With both sides having an extreme case of ongoing rectal cranial inversion.

Just a few thoughts from somebody who has been on both sides of the issue.

Btw, I’ve seen Maximus work product in several areas (not this particular one, but others). They’re not bad.

Comment by Judgment Day Tuesday, Sep 18, 12 @ 11:22 am
@Yellow Dog Democrat

I understand that. However, I don’t see where using paystubs clearly and completely tells the whole current income story. Why not require both the paystubs AND income tax returns? What would be the harm?

Comment by Income Verification? Tuesday, Sep 18, 12 @ 11:23 am
Republicans want to scrutinize Medicaid applicants to catch cheaters. We might find more revenue by scrutinizing tax returns, and going after those making Internet purchases but not paying the state sales tax.

Comment by reformer Tuesday, Sep 18, 12 @ 11:29 am
official paystubs are also not going to help on the folks working off books. Now most of these folks probably don’t make enough for it to matter, but it is dishonest.

Comment by cermak_rd Tuesday, Sep 18, 12 @ 11:32 am
I ask, because I have heard individuals “bragging” in waiting rooms of medical offices about how they only turned in one set of paystubs to get a medical card…and that they haven’t ever been “caught” hiding the other paystubs, because nobody ever asked for more information. Wouldn’t an income tax return ALSO assist the Department in ensuring that the individual )who is required to prove eligibility annually) actually qualified last year of medical expenses? Wouldn’t this be a relatively easy form of fraud prevention that wouldn’t cost the state additional dollars? for new applicants, wouldn’t last year’s W-2s also show the Department that multiple jobs may have been worked the previous year…so maybe further investigation is needed to prove eligibility?

Comment by Income Verification? Tuesday, Sep 18, 12 @ 11:33 am
Let’s us never forget that Billboards & Company demanded the outside consultant to scrub the lists and the contract had to go through the vaunted procurement process. They are very lucky this got out as soon as it did.

Comment by CircularFiringSquad Tuesday, Sep 18, 12 @ 11:36 am
Re: Income tax returns.

I’m talking practical here. Many programs don’t want to get anywhere near having to handle and have copies of federal tax information. There’s lots and lots and lots of issues associated with that data, and as pointed out, it’s also a snapshot in time that under the best of circumstances is at least a year old.

And as much as I hate to admit it, having more information is not always a good thing. Sometimes having more paper just clogs up the system, and makes the reviewers life more difficult.

Just the .02 cents of somebody who wants less complexity.

Comment by Judgment Day Tuesday, Sep 18, 12 @ 11:40 am
to income verification…under All Kids when Blago rolled the program out it required that only one pay stub be submitted. In numerous meetings agencies were told to use the one that had the lowest amount in wages. So if people are saying this in waiting rooms they were not getting over on the system, since that is the way the system was designed. That said, it is a whole other issue as to whether it should have ever happened.

Comment by illinifan Tuesday, Sep 18, 12 @ 11:46 am
I wonder how Maximus will track voluntary asset transfers by seniors as an estate plan to get on the Medicaid rolls.

Comment by Cook County Commoner Tuesday, Sep 18, 12 @ 11:53 am
@illinifan
Interesting, but sad, information. So, if I was willing to act unethically and illegally, I could work my full-time job, plus an additional part time job. I could then apply for Medicaid (and probably SNAP)by providing DHS with only my paystubs from my part-time job, nobody would further question me? You’re telling me that I would be considered eligible for these tax-funded benefits, eliminate my pre-tax deduction of my outrageous health insurance premiums (Medical Card), and possibly reduce my grocery bill (LINK Card)?!?! Wow.

Comment by Income Verification? Tuesday, Sep 18, 12 @ 11:53 am
===if I was willing to act unethically and illegally===

If you were willing to do that, you could do a lot of things, like rob a bank.

Comment by Rich Miller Tuesday, Sep 18, 12 @ 11:56 am
I’m not talking about robbing a bank. I’m referencing how the state and its taxpayers are currently being robbed.

Comment by Income Verification? Tuesday, Sep 18, 12 @ 11:58 am
IV? - It’s called fraud, and people do it every day in many different forms. Some get away with it, some don’t; some are poor, some are rich.

If you can come up with a foolproof plan to eliminate it without costing more than the fraud itself, I’m 100% positive the GA and Governor would support it.

Let me know what you come up with.

Comment by Small Town Liberal Tuesday, Sep 18, 12 @ 12:01 pm
Re: Medicaid cheaters.

Again, thinking practical. The “Let’s hunt down the Medicaid cheaters” is a nice hot button to push, but that’s not where the real money is.

It’s really all about the workflow process. First step for me is to create what are called “Mindmaps” (there are software programs to assist one in doing this) which are visual representations of how the work process occurs (or is supposed to occur).

Then you have something to baseline against. And then you can figure out how you can make things work better.

Just as a btw, I recently watched an operation improve dramatically by just doing something simple. Whenever they had to send out mail (a lot), the ‘mail to’ name and address had to be run through their laser printers on those 30 labels to a sheet forms - or printed by hand.

They went out & bought a number of LabelWriters (1 per desk) that allows them to print individual labels (and USPS postage also). Less than $90 each for hardware & software. Worked like a charm. Not only did things become measurably more efficient (to this day), but everybody got a little less stressed.

So you don’t always have to do big time fancy spending plans. Sometimes it’s all about sweating the small stuff. And trusting your people.

Comment by Judgment Day Tuesday, Sep 18, 12 @ 12:03 pm
STL? - Oh, I’m supposed to solve Medicaid fraud on my lunch hour for demonstrating that frauding our state has been allowed and appears to be relatively easy to commit? - which is apparent since the state has has to secure a contract with Maximus to go after current recipients in question. As a first step, how about ensuring that folks are truly eligible at the time of application? I’d look at illinifan’s post at 11:46.

Comment by Income Verification? Tuesday, Sep 18, 12 @ 12:16 pm
My grandfather was a fraud investigator for the state. Most “fraud” involves providers, not recipients.

Why? The penalties for Medicaid fraud are pretty harsh, and can include jail time. But no patient “makes” money off of Medicaid fraud. On the other hand, providers who think they’ve figured out a way to game the system…by billing for unnecessary services or services that were never delivered…can make millions.

Who would risk jail time to get medical services they can otherwise afford? Not many.

Are there people who would risk jail time to make millions? Yes.

Comment by Yellow Dog Democrat Tuesday, Sep 18, 12 @ 12:19 pm
Contractors to “scrub” Medicaid rolls? Isn’t that what MSI was all about?

Comment by Anyone Remember? Tuesday, Sep 18, 12 @ 1:03 pm
IV:

Let’s do a strip search of them while we are at it. Maybe they are hiding income in body crevices.

Comment by Demoralized Tuesday, Sep 18, 12 @ 1:05 pm
and let’s give them a smack or two anyway, since if they aren’t guilty of Medicaid fraud they are almost certainly guilty of something else; as a matter of fact we could adopt the old Vietnam standard, just kill them all and let God sort them out. They all look alike anyway.

Comment by steve schnorf Tuesday, Sep 18, 12 @ 1:17 pm
Not what I said “income verification” since state offices have immediate data matches with DOL. If a person provides one pay stub from one job, but DOL shows multiple jobs, the workers inquire and ask for proof of the other income, including that it ended. If all the data shows only one job and a pay stub is provided then only one pay stub was used. That did not give a full picture of the actual wage so recently it was expanded to provide 30 days of income proof. You also have to fit a program category to get the coverage either by having children in the home (which you have to prove they are there), or being 65+, blind or disabled. So you can’t just walk in and get benefits. Yes some people lie, but once a year tax returns are filed, and then the state has a data match with IRS to pick up on unreported income. If the person is paid cash, guess what the state workers will question people who say rent and bills are paid but they have no income, and the person has to provide some proof how they have been managing to live on nothing. It is not the easy process many people believe it is. Fraud will exist but it is not the level everyone thinks it is and represents about 10-15% of the people. Too high but let’s not villainize the 85-90% who are receiving what they are eligible for.

Comment by illinifan Tuesday, Sep 18, 12 @ 1:18 pm
Yellow D has it on the mark. Go after the BIG dogs - yet that might get, um, complicated with politicians in need of $$$. Bums. How many investigators of Big Vendors are there?
Billion$ of bucks and a handful checking it out. It gives the impression of anti- fraud measures, but not serious focus
Bums I tell ya….

Comment by Anonymous Tuesday, Sep 18, 12 @ 1:44 pm
Who makes money on Medicaid fraud? The state doesn’t cut you a check for going to the emergency room.

The folks getting paid are the health-care providers.

This is what Illinois GOP leaders have to talk about? And they claim some sort of electoral conspiracy.

Has the collective GOP lost its mind? For crying out loud, they see the people as the enemy of the government.

Comment by wordslinger Tuesday, Sep 18, 12 @ 1:45 pm
“wordslinger” health care providers do make money and do commit Medicaid fraud but that is not the sole driver of Medicaid fraud. This keeps circling the general issue of access to health care. If there was universal access, then we would not spend time and money tracking Medicaid fraud since all persons would have coverage. That would be a huge cost savings to the health care system. We then need to tackle how people use health care and particulary the ER. Many people go to the ER for basic care since they know since 1986 all ERs have to treat patients regardless of the ability to pay. As a result of this, an ER then became the primary care provider for the uninusred. We need to change that process, and would reduce some costs. I agree with you some how we have to quit making people the enemy and quit making the government the enemy. We are partners in this mess, and until we stop standing in a circular firing squad shooting at the enemy we won’t get anything done.

Comment by illinifan Tuesday, Sep 18, 12 @ 1:55 pm
It’s expected thatMaximus will “electronically” examine income, assets, etc. a great idea, but there’s no way to perform the job at the current time. The only database that indicates income per quarter, is always at least 90 days behind. The goal is to limit or stop physical contact with applicants which if successful would lower the need for staffing! Think it’s a mess now…you ain’t seen nothin’ yet!!!!

Comment by Steamer Tuesday, Sep 18, 12 @ 2:56 pm
Anyone in the general assembly complaining about a project time frame when they’ve accomplished nothing yet on pension reform is laughable.

But Medicaid fraud investigation is a project that cries out for some nepotism - Maximus should hire a relative of one of the republican members of the general assembly to work on this project and also task the relative with briefing republican members of the General Assembly. When he/she finds out that Medicaid fraud by recipients isn’t as widespread as believed, maybe they’ll complain less.

Comment by Robert the Bruce Tuesday, Sep 18, 12 @ 3:22 pm
illini

The problem is state policy regarding income. For years, with passive redetermination, All Kids recipients were not required to report or verify income if they only wanted to receive mdical for persons 19 or under. Income only needed to be reported if coverage was desired for adults. It is possible that the number of ineligible households approaches 25%, but my experience of 32 years on the front lines as a caseworker & casework supervisor makes me feel this is probably a little on the high side. We have computer access to the department of labor data, which allows us to see current unemployment benefits being received and earnings (updated quarterly). We also receive cross matches about tax returns and bank accounts. We also have access to the Social Security system, which shows current SSI & RSDI benefits. One of the problems we encounter is failing to report a spouse with income in the home. We frequently catch these through birth records from the Vital records clearances we have access to. We match the Social Security Number of the parent with employment records & other income sources previously named. If there is any indication of fraud an investigator is sent out. A very large number of cases we send for investigation are cancelled because it is determined that the father of the children is present in the home. Te idea being discussed out here that a person can only report one job & not the other isn’t true.

“@illinifan
Interesting, but sad, information. So, if I was willing to act unethically and illegally, I could work my full-time job, plus an additional part time job. I could then apply for Medicaid (and probably SNAP)by providing DHS with only my paystubs from my part-time job, nobody would further question me? You’re telling me that I would be considered eligible for these tax-funded benefits, eliminate my pre-tax deduction of my outrageous health insurance premiums (Medical Card), and possibly reduce my grocery bill (LINK Card)?!?! Wow. “

Comment by AFSCME Steward Tuesday, Sep 18, 12 @ 6:07 pm
“Medicaid roles”? Anybody at the Pantagraph paying attention?

Comment by DuPage Dave Tuesday, Sep 18, 12 @ 6:25 pm