Thursday, March 31, 2011

Senate Republicans Push for Medicaid Reform

Senate Republicans are offering a series of Medicaid reforms designed to crack down on waste and abuse in the state’s Health Safety Net program uncovered by the Inspector General.

Senate Minority Leader Bruce Tarr (R-Gloucester) and Senators Robert Hedlund (R-Weymouth), Michael Knapik (R-Westfield) and Richard Ross (R-Wrentham) are calling for better verification of applicants’ Medicaid eligibility, improved safeguards to prevent duplicate payments or payments for medically unnecessary procedures, and an audit of the state’s Medicaid program by the Inspector General. All three proposals are scheduled to be taken up this afternoon when the Senate debates a $325 million FY2011 supplemental budget.

Earlier this week, the Boston Herald reported that the state’s Uncompensated Care Pool – which is funded through contributions by taxpayers, health insurers and hospitals – paid out $414 million in 2009 for 1 million emergency health care claims. According to the Inspector General, $7 million was used to provide health care for non-Massachusetts residents, $17.8 million was spent on “medically unlikely” or “medically unnecessary” claims, and $6 million went towards payments on 13,000 duplicate claims.

“We find it extremely troubling to learn there are such lax procedures in place that have allowed so many people to take advantage of the system,” said Senator Tarr. “At a time when health care costs continue to grow at an unsustainable rate, we simply cannot allow such waste and abuse to continue.”

Although the Health Safety Net was intended to be limited to Massachusetts residents only, the Inspector General’s report found the state does not even require individuals to provide a Social Security number to help verify their assets and eligibility. As a result, the fund was used to provide health care for residents of 48 other states and even other countries.

The Senate amendments would:

- require applicants to provide a Social Security number on all medical benefits request forms, require verification of an applicant’s eligibility prior to payment, and prohibit payments for individuals who have other insurance coverage;

- require the Office of Medicaid to develop regulations to improve record-keeping and minimize the likelihood of paying for duplicate or invalid claims; and

- authorize the Inspector General to conduct a comprehensive audit of the state’s Medicaid program and report back to the Legislature with his findings by April 1, 2012.