Computer upgrade aims to improve Medicaid eligibility checks

November 16, 2018 GMT
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Sen. Sharon Hewitt, R-Slidell, left, and Rep. Tony Bacala, R-Prairieville, talk about a Medicaid audit during a Joint Legislative Committee on the budget hearing on Friday, Nov. 16, 2018, in Baton Rouge, La. (AP Photo/Melinda Deslatte)
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Sen. Sharon Hewitt, R-Slidell, left, and Rep. Tony Bacala, R-Prairieville, talk about a Medicaid audit during a Joint Legislative Committee on the budget hearing on Friday, Nov. 16, 2018, in Baton Rouge, La. (AP Photo/Melinda Deslatte)

BATON ROUGE, La. (AP) — Gov. John Bel Edwards’ administration told lawmakers Friday a computer upgrade will address concerns the Medicaid program has spent millions on people not eligible for the coverage, and the system improvements won praise from the state’s top auditor.

The Legislature’s joint budget committee approved the contract needed for the upgraded system, which launched this week as Legislative Auditor Daryl Purpera released a report that said Louisiana’s Medicaid expansion may have spent as much as $85M on ineligible enrollees.


Auditors suggested more double-checking of Medicaid recipients’ income, saying 20 other states that expanded Medicaid under the federal health overhaul law do more frequent income reviews than Louisiana has done.

Commissioner of Administration Jay Dardenne, the governor’s chief budget adviser, said the upgraded system the health department began using Tuesday will do quarterly checks of eligibility, rather than the annual checks previously done. Dardenne said the system also will use more data for comparison, six different sources to track a person’s wages.

“We’re going to be making more determinations with real-time, accurate data,” he said.

Purpera described the upgraded computer system as “a very good change.” And Dardenne said federal Medicaid officials visited this week and “were very pleased and surprised with the quality of this new system.”

Review of the audit findings Friday triggered the latest disagreements between Republicans and Democrats over management of a Medicaid program that costs nearly $13 billion a year. Edwards, a Democrat, expanded Medicaid after taking office in 2016, offering government-financed health coverage to thousands more people. Republicans criticize the move as unaffordable in the long-term. The expansion is mainly financed with federal money.

In a series of pointed exchanges, Democrats questioned whether Purpera’s office has focused disproportionately on Medicaid, and whether auditors’ data was skewed. They noted the health department’s eligibility review process met federal standards.

“I question why we continue to target Medicaid, Medicaid, Medicaid,” said Rep. Dustin Miller, an Opelousas Democrat.

Sen. Jay Luneau, an Alexandria Democrat, said the auditor’s office shouldn’t “alarm the public about things that may or may not be.”


“Sir, with all due respect, there is no speculation in this report,” Purpera replied.

Purpera’s office used a random sample of 100 Medicaid recipients in the expansion program, to check if their income exceeded the eligibility threshold. Projecting those results across the expansion population, auditors wrote, suggests the health department spent between $61.6 million and $85.5 million over 20 months on people who weren’t eligible.

“This is a large error,” said Rep. Blake Miguez, an Erath Republican.

Republican Rep. Cameron Henry, budget committee chairman, noted the health department didn’t dispute the audit’s findings.

Both Purpera and health department officials said they don’t expect the state to owe repayment of federal Medicaid dollars because Louisiana followed federal guidelines. But the health department sent out letters seeking to recover money from people deemed ineligible.

Mandy Schwalb, 38, a New Orleans event planner, received a letter demanding she repay $5,089 though she never sought Medicaid enrollment or received patient services from the program.

Schwalb sought information about buying health insurance through the federally run marketplace, but instead chose to maintain other insurance. However, federal officials determined, based on information she provided, that Schwalb was eligible for Medicaid expansion and forwarded that information to Louisiana. The health department enrolled her, auditors said, and Schwalb was later deemed ineligible because she earned too much money.

Schwalb never received the money. It was paid to a Medicaid managed-care company.

“Why does she have to pay it back if they got it?” asked Rep. Larry Bagley, a Republican from Stonewall.

Medicaid Director Jen Steele said the health department won’t pursue repayment from Schwalb or others who didn’t know they were enrolled, but will seek recoupment if someone tried to fraudulently receive Medicaid.


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