Del. Ken Plum: Medicaid in Perspective

by Del. Ken Plum November 19, 2015 at 1:30 pm 6 Comments

Del. Ken Plum/File photo This is an opinion column by Del. Ken Plum (D), who represents Reston in Virginia’s House of Delegates. It does not represent the opinion of Reston Now.

A recent newspaper headline proclaimed that “Audit finds waste, inefficiencies in Virginia’s Medicaid program.” As often is the case, the real story is beyond the headline.

The audit described in the story is the 62nd audit
of Virginia’s Medicaid program since 2002. This one was conducted by the Joint Legislative Audit Review Commission (JLARC) of the General Assembly. The audit was mandated by the Republican majority of the General Assembly, who oppose the expansion of Medicaid for the working poor. As JLARC explained the context of the audit: “Medicaid eligibility determination in Virginia is undergoing significant changes, including new policies for most Medicaid applicants and a new information system used for all applicants.”

Is it any wonder that under such circumstances there would be some audit findings related to verification of eligibility?

In looking at the details of the report, the biggest problem with eligibility determination occurs where the caseload is highest. In Loudoun County, for example, an eligibility worker is responsible for 1,221 cases; in Chesterfield County near Richmond each eligibility worker is responsible for 1,230 cases. It should be no surprise that with such limited staffing and a changing system there would be delays and errors.

Measured against federal standards, Virginia’s error rate of 0.5 percent in approving Medicaid eligibility was far lower than the national average of 3.3 percent in 2012. Even with the changing standards, the current rate at 2.7 percent is less than the national average.

In 2014, 1.2 million Virginians received Medicaid benefits. Only certain categories of Virginians are eligible for Medicaid. They must fall into one of five primary eligibility categories — children under age 19, parents or legal guardians of a dependent child, pregnant women, persons aged 65 or older, or disabled or blind –and they must have income below the appropriate percentage of the federal poverty level for their eligibility category. Over half of those enrolled in 2014 were children and nearly half of the $7.9 billion in payments went to those who are disabled or blind.

As the JLARC report found, “the eligibility determination process is complex and involves multiple federal, state, and local agencies.” While the goal may be to have no errors, the level of performance in Virginia is much better than the national average and is quite remarkable considering the kind of change the program is currently undergoing. The JLARC report concluded that “the state may have spent between $21 million and $38 million on individuals no longer eligible,” or less than 0.5 percent at a maximum.

No estimate is offered for the cost to the recommended remedies, but certainly they will exceed the cost of the perceived problem — fraud and waste. In addition to costs, the proposed solution opens up a myriad of large data bases on personal finances, real estate holdings, and employment that the General Assembly may not wish to make available to state agencies. The report has no mention of the amount the state will recover; nor does it mention in the case of fraud that the Attorney General’s Medicaid fraud unit was found in 2013 to be the best in the country.

Opponents of closing the coverage gap for an estimated 400,000 working Virginians will no doubt nitpick the latest report and use it as an excuse for not taking action. Such a misuse of information will be felt by the neediest of Virginians.

  • meh

    why not just bring in some college students who are receiving state aid to attend college in as interns to help with the case load? We don’t ask for much, we just want our free stuff to go to legal residents of Virginia that qualify for it, and not to dirty Marylanders trying to escape their failed state.

    • Obstreperous Troll

      meh… dirka dirka dirka

  • Ming the Merciless

    No estimate is offered for the cost to the recommended remedies, but
    certainly they will exceed the cost of the perceived problem — fraud and waste.

    Certainly I would object to your use of the word “certainly” there, Ken. But like all Democrats you couldn’t care less about government waste and fraud (unless perhaps it is in the Pentagon) because it’s just Other People’s Money.

  • Greg

    Government fraud and waste is a perceived problem? Surely you jest, Ken!

    Certainly we can agree that fraud and waste in government exist and often the three words are used together in documenting very real waste and fraud of hard-earned middle-income-peoples’ money (after all neither the poor nor the rich pay enough, right?) — often in Medicaid and Medicare. At least $500 billion according to one credible source. http://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/

  • east297

    Please someone…anyone run against this incompetent the next time he is up for election!

  • Bob

    I reported 20 years of State Audit discrepancies to the Virginia Medicaid Innovation and Reform Commission, which meets less frequently than the Virginia Legislature does it appears. http://mirc.virginia.gov/public_comments/-%20Public%20Comments%20Received%20Prior%20to%20the%20Next%20Meeting%20Date%20TBD/Robert_Young.pdf first reported in the Summer of 2014.
    In these drug rebate reports, Virginia Medicaid reported collecting some $300 to $1 billion more than federal CMS Medicaid Financial Management reports show, and evidently didn’t send back the federal governments “share”. As for QMB’s, [pronounced “quimbies”] these are only poor seniors, and blind and disabled Virginian’s, which I can’t determine which most of these are, while State taxpayers pay for their Medicare premiums and Medicare pays for their drugs that CMS receives 35% rebates on while Virginia receives 50% rebates on Medicaid drug purchases, if they aren’t disputed by manufacturers.
    I’ll bet most of these “QMB’s” aren’t blind or seniors as the world after 2007 caused a lot of disabilities, which should be checked first!


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