MEDICAID REPAIR WORK

Rep. Kevin Glynn of South Portland recently announced his concerns about Maine’s Medicaid billing failure that began last January but that, according to the federal Centers for Medicare and Medicaid Services (CMS), has improved considerably since. He is correct to be concerned – everyone who has looked at the problem has been concerned; Gov. Baldacci was concerned enough to remake the management and systems teams surrounding the issue. But Rep. Glynn’s conclusion that the federal government could “shred Maine’s Medicaid safety net,” in the words of his press release this week, is not supported by a recent CMS report on the subject.

Rep. Glynn, according to news stories, raised doubts about whether the federal government would continue to send Medicaid money. “They have taken so long to work on the computer problem and made so many mistakes,” he said of the state, “that Maine’s entire Medicaid system – MaineCare – is in jeopardy.”

Anything’s possible, but the question before the Department of Health and Human Services was whether CMS would continue to fund the upgrade of the failed billing system. Consider a very different conclusion in the CMS review: The Maine Claims Management System “appears to be headed in the right direction and is sufficiently viable to justify additional federal support,” it said, noting the high clearance rate of claims and the broad reduction in backlogged claims.

The state has much more work to do to make its billing system work as it should, but the news overall is encouraging after what was a dismal stretch for DHHS. That should make the public react with caution to Rep. Glynn’s very serious charge that “thousands of claims have simply gotten lost in the confusion” and there is a fear “that many of these claims will never be found.” There are, in fact, a huge number of claims that have yet to be adjudicated; more than 130,000 have been sitting around for more than three months. But that’s different from being lost, which would be a new level of incompetence in this sorry experience.

Among the risks identified by CMS were that Maine may not have a proper management system in place to get the computer repairs done on time; that Maine’s testing for new systems is inadequate; and that it should test its coding more thoroughly before putting it into effect. The CMS team listed a dozen high- and medium-level risks, mostly with technical aspects of the computer repair. If Maine wants to keep the federal Medicaid dollars flowing, it might, with a minimum of hyperbole, focus on meeting those expectations.