GOP lawmaker, DHHS clash over Medicaid losses

AUGUSTA – The Maine Department of Health and Human Services and an outspoken Republican lawmaker clashed Wednesday over the scope of potential losses the state faces as a result of failures in the agency’s new claims-processing computer system that provides Medicaid reimbursements to hospitals and health care providers.

Prolonged computer software glitches at DHHS are causing the state to miss deadlines for submitting reimbursement claims to the federal government and could potentially “shred Maine’s Medicaid safety net,” said Rep. Kevin Glynn, R-South Portland.

“It could create a monster hole in the state budget, because we have claims now already a year old,” said Glynn, who is a member of the Legislature’s Health and Human Services Committee. “As we approach January, the number will increase exponentially. They have taken so long to work on the computer problem, and made so many mistakes, that Maine’s entire Medicaid system – or MaineCare – is in jeopardy. We could be out literally hundreds of millions of dollars.”

Michael Norton, a DHHS spokesman, acknowledged some losses could result from the extended repair schedule for the department’s computer system, but nothing that would approach the “hundreds of millions of dollars” estimate.

“Not only are those numbers dramatically overstated – they’re made-up numbers,” Norton said. “They’re whole cloth made-up numbers from somebody who’s had the opportunity to get the facts. And instead of following the facts, [Glynn’s] putting out these ‘sky is falling’ press releases that are not based on any of the information he’s been given.”

During a Wednesday interview and in prepared remarks, Glynn said his concerns over the financial exposure for the state were shared by Mary Mayhew, vice president of government affairs for the Maine Hospital Association. During a Sept. 21 meeting of the Legislature’s Health and Human Services Committee, Mayhew said Maine hospitals were owed more than $100 million as a result of the problems with the DHHS computer system.

In a letter to the committee, Mayhew wrote that of the approximately 500,000 claims submitted by Maine hospitals since January, 360,000 valued at more than $100 million remain unresolved. Also worried about the reimbursement timetable, Mayhew said the federal government stipulates that in order for the state to receive federal matching dollars, the state has to properly receive and acknowledge a claim for Medicaid service within a year of the date of service.

Glynn said this year, Maine will spend nearly $2.6 billion on Medicaid for about 300,000 low-income residents. Acknowledging that the federal government would contribute more than $1.4 billion of the total if the claims management process worked smoothly, Glynn said the process has been compromised by a computer system plagued by serious software and hardware problems from the start.

While thousands of providers are not getting paid for handling Medicaid patients, he said others have been overpaid by about $51 million and thousands of claims may have simply gotten lost in the confusion.

Mayhew said there was a real concern that many of the claims may never be found by the state, adding that “if the state fails to provide accurate remittance statements for claims filed, hospitals may never receive payment for those patients.”

The Legislature’s Appropriations Committee is scheduled to receive an update on the computer program today when DHHS Commissioner Jack Nicholas and Department of Administrative and Financial Affairs Commissioner Rebecca Wyke address the panel.