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In the shadow of Silicon Valley, the hub of the world’s digital revolution, California officers nonetheless submit their data to the feds justifying billions in Medicaid spending the old school approach: on paper.
Stacks and stacks of it.
Stuck with decades-old know-how, the nation’s largest Medicaid program forces federal officers to sift via hundreds of paperwork by hand moderately than sending digital recordsdata. That’s one of many crucial findings in a Sept. 5 report from the federal authorities’s chief watchdog citing inefficient and lax oversight of Medicaid nationwide.
To illustrate, the U.S. Government Accountability Office revealed a photograph displaying piles of data submitted for one three-month interval. One folder was positioned upright to point out the peak of the heap.
“It’s really amazing when you look at that picture,” mentioned Carolyn Yocom, a well being care director on the GAO who focuses on Medicaid, the federal-state medical health insurance program for low-income individuals. “For this type of reporting on expenditures, California really should be able to provide that electronically.”
California, with greater than 13 million Medicaid enrollees, mentioned it’s hamstrung as a result of it makes use of 92 separate laptop techniques to run its Medicaid program — though it has plans underway to modernize its know-how.
“Given system limitations and the magnitude of the supporting documentation, providing it electronically is currently not feasible,” the California Department of Health Care Services mentioned in a press release.
The state’s Medicaid program, often known as Medi-Cal, has struggled with know-how for years. The state thought it had an answer in 2010 when it awarded a $1.7 billion contract to Xerox, which included $168 million for a brand new system. But after years of delay, the state scrapped the contract in 2016 and began from scratch, leaving the patchwork system in place a number of extra years.
Nationwide, regardless of trade buzz about digital medical data, smartphone apps and synthetic intelligence, plenty of paper remains to be being pushed throughout the well being care system. Consider all these kinds sufferers repeatedly fill out within the ready room, the screeching sound of fax machines inside medical doctors’ workplaces and the bulging binders of sufferers’ data in file rooms.
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Under Medicaid, states submit knowledge quarterly to the federal authorities on their spending and embrace supporting paperwork comparable to invoices, value experiences and eligibility data. In California, experiences on spending are shared electronically, however the copious supporting documentation required for federal assessment just isn’t, in accordance with the GAO.
When the Xerox enterprise failed, the corporate agreed to pay California greater than $123 million as a part of a settlement settlement, in accordance with state officers.
Meantime, Conduent, the companies unit of Xerox that was spun off right into a separate firm, was left to maintain working the system and course of claims.
Last month, the state awarded a contract to DXC Technology of Tysons, Va., to take over some operations from Conduent. The state mentioned the contract may very well be value $698 million over 10 years.
Separately, California’s Medicaid officers are engaged on plans for a brand new system that may value an estimated $500 million. Under the federal-state partnership on Medicaid, the federal authorities would cowl 90 p.c of these prices for design and implementation, and the state’s share can be about $50 million.
Pressure has been mounting on California to repair the scenario. The Medicaid IT system “needs to be replaced, because it is more than 40 years old, its operations are inefficient, maintaining the system is difficult and there is a high risk of system failure,” state auditor Elaine Howle wrote in a June 26 letter to Gov. Jerry Brown and legislative leaders.
In her letter, Howle mentioned the state was paying about $30 million yearly to take care of the legacy system.
Overall, Medi-Cal serves 1 in three Californians. The annual Medicaid funds in California is about $104 billion, counting federal and state funds.
Beyond California, the GAO criticized the U.S. Centers for Medicare & Medicaid Services (CMS) extra broadly. One criticism: Federal officers assign an analogous variety of employees to states for reviewing case recordsdata — despite the fact that some states, like California, pose a far larger danger for enrollment errors and misspent cash because of their measurement and complexity.
For occasion, the report’s authors mentioned, CMS reviewed claims for a similar variety of newly eligible Medicaid enrollees — 30 — in California because it did in Arkansas, despite the fact that California had 10 occasions the variety of newly enrolled sufferers below the Affordable Care Act.
The report additionally mentioned CMS devoted an analogous variety of employees to assessment each California, which represents 15 p.c of federal Medicaid spending, and Arkansas, which accounts for 1 p.c.
CMS “needs to step back and assess where are the biggest threats and vulnerabilities,” Yocom mentioned. “If you aren’t looking, you don’t know what you aren’t catching.”
Overall, from fiscal years 2014 to 2018, federal Medicaid spending elevated by about 31 p.c, in accordance with the GAO report. But the full-time employees at CMS devoted to monetary oversight declined by roughly 19 p.c over the identical interval.
In a July 18 letter to the GAO, the U.S. Department of Health and Human Services agreed with the company’s suggestions for enhancing oversight efforts.
HHS wrote that it “will complete a comprehensive national review to assess the risk of Medicaid expenditures reported by states and allocate resources based on risk.”
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This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.
Chad Terhune: [email protected]”>[email protected], @chadterhune
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