If the Baldacci administration wants to kill the expansion of public health care in Maine, all it has to do is deny providers’ Medicaid bills and blame the denial on computer trouble. That is essentially what is happening with physicians, dentists, therapists, nursing-care providers and others, and it is unacceptable.
The state has a new, federally required computer system, and no doubt it does have problems, as the administration claims. The Bureau of Medical Services would have known about these problems before it began using the system in January and should have made getting payments to providers its priority, rather than forcing the people delivering care to submit the same form over and over. The Department of Health and Human Services is forever scolding health care providers about their costs and lack of efficiency. In this case, DHHS is the cause of costs in the form of loans providers need to cover the missing state payments and the cause of inefficiency as providers spend their time trying to track down the right person in government to solve the problem.
The administration also talks a lot about access to care for the poor, but what doctor wants to go bankrupt while providing these services? As if the reimbursements weren’t low enough before, they are now nonexistent for many. The argument from the state, presented in a news story Tuesday about the issue, that no one noticed for weeks that the new computer was rejecting provider bills, is not believable.
The Health Insurance Portability and Accountability Act, the 1996 federal legislation that is prompting states to overhaul their Medicaid computer systems, was designed to simplify reporting while improving security. It was supposed to save billions of dollars by reducing the ten of thousands of proprietary codes. It also urges states to anticipate problems such as interrupted payments to providers.
What is occurring to Maine Medicaid now is not a computer “glitch.” It is a serious failure to make certain a crucial link between the state and providers, even those who fill out Medicaid forms incorrectly, worked before relying on it. That failure is expensive and is most harmful to the providers whose practices most often treat the poor. In Augusta, politicians debate whether to extend Medicaid coverage to one group or another with the assumption that providers will be there to offer care.
That’s not an assumption that will hold up under the kind of treatment they are receiving now.
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