Maine’s Medicaid slated for overhaul Structural problems plague MaineCare

AUGUSTA – The Department of Health and Human Services plans an overhaul of Maine’s Medicaid program after a consultant hired by the state identified problems that have plagued the program for decades.

During a review of a faulty new computer system, the New York firm of Deloitte Consulting identified numerous problems within the system known as MaineCare, said Mike Hall, deputy commissioner at DHHS who will oversee the overhaul.

As it now stands, the agency doesn’t pay its bills on time, respond to the Legislature’s directives, provide good customer service or offer employees a good place to work, Hall said.

“The organization … has been in a state of crisis and turmoil for longer than any of us can remember,” Hall said. “It’s not a place that is capable right now of functioning at its best level, and we need to move it to that place.”

MaineCare spends $2.6 billion a year in federal and state funds on health care services for more than 300,000 low-income Mainers. At a State House press conference Wednesday, Hall said consultants will continue with their probe of the agency until October.

Hall said management at MaineCare has lacked needed resources and technical skills and that a new $22 million computer system installed in January is not working properly.

Clients are not getting services and providers are not getting paid as quickly as they should, Hall said. Earlier this year, the agency overpaid providers by about $51 million after rejecting their claims.

But the problems run much deeper than software and hardware problems, Hall said.

“If we don’t get at the underlying structural issues, the state is vulnerable to the same problems like this in the future, and we have to address those now in a preventative way,” Hall said.

The consultants plan to meet with providers as well as clients to help craft the blueprint for a revamped program, he said, and implementation of the changes likely will continue well into next year.

The goal, he said, is to organize the agency like a business.

“We’re not simply shifting around resources and making small incremental changes,” he said. “We are in essence designing a new MaineCare agency for the state of Maine.”