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State Medicaid Director Blasts Flawed Framework

Jan 15, 2020

The Ohio Department of Medicaid director says her agency is dealing with big problems and could face huge fines from the federal government if they’re not fixed. 

And she’s pointing to the administration of former Governor John Kasich for creating and not handling those mistakes. Ohio Public Radio's  Karen Kasler reports.

The memo is scathing.

Medicaid director Maureen Corcoran uses words such as “inadequate”, “unacceptable”, “poorly implemented” and a “mess” to describe what she inherited after being appointed by former Governor John Kasich’s fellow Republican and successor Mike DeWine. Of the Kasich–backed plan to move providers of addiction and mental health treatment for low-income Ohioans into the Medicaid managed care system, Corcoran writes: “The implementation was the worst I have seen in my professional career of more than 30 years.

And she says that implementation was hampered by what she calls “questionable decisions”, system flaws that were big and numerous, and “overall mistrust and poor communication”. That behavioral health redesign caused delays of millions of dollars in payments and even led to some providers shutting down.

But in a conference call discussing the memo, Corcoran says she’s not just a flamethrower pointed at her predecessors.

“It's not about pointing fingers or denigrating good work that was done by the prior administration. But it is about sort of clearing the air so that these things that have very real operational implications don't get tangled up with what we'll be laying out even more fully in the weeks ahead.”

Among other things, Corcoran means work requirements for as many as 60,000 people in Medicaid expansion, set to go into effect next January.

And Corcoran says as Medicaid gets that up and running, she’s having to repair issues she’s found with several parts of the program. For instance, a federal audit found Ohio’s error rate for determining Medicaid eligibility was double the national average – which doesn’t mean there were improper payments made or that people were kept out of the program. But she says it does mean that the state wasn’t doing what it was supposed to, and that’s why the feds told her that the state could have been fined almost $6 billion.

“I don't anybody to misinterpret this as we're saying, we're going to pay back $6 billion. We're gonna have to pay back, we think, about $88,000. But down the line, if we don't remedy this, then we could be looking at penalties of that magnitude.”

Corcoran says Medicaid is trying to replicate the mistakes the audit found to figure out if they’ve been fixed. And she also says she found a backlog of cases that she describes as longstanding and unacceptable.

In the memo, Corcoran says the $1.2 billion Ohio Benefits System that processes applications has forced employees to use thousands of workarounds for basic tasks. And she says there have been big mistakes in documentation generated by the system, such as private information being released to other recipients, inaccurate dates that can affect renewals and disappearing paperwork.

A spokesman for Kasich is pushing back. Jim Lynch didn’t agree to an interview, but provided a recorded statement defending his former boss.

“When Governor Kasich came into office we had an $8 billion shortfall due in no small part to unsustainable growth in Medicaid. So we got to work to reform the program, cut the cost growth from nine percent to below four percent, and covered 700,000 more people. The state’s leadership now has the opportunity to build on eight years of progress.”

John Corlett was the director of Ohio Medicaid from 2007-2009, under Democratic Governor Ted Strickland. He’s now with the Center for Community Solutions, a policy research group in Cleveland. He admits he hasn’t seen anything like this memo.

“I haven’t. But I mean, this program is so important, it’s important to get the details right. It’s important to get the program right.”

Corlett gives credit to Kasich for expanding Medicaid, but says he’s concerned that people who are eligible for Medicaid aren’t getting it or are falling out of the program needlessly. So he’s hoping those at the agency now are reaching out to people on the front lines.

“Those caseworkers and those application assisters and those community agencies and those large Medicaid providers – let’s talk to them. Are their patients, are their clients, are the people who live in their neighborhoods able to access this program in a reasonable way, in a timely way? I think that’s where we should focus our efforts. I don’t think we should be talking about blame.”
 

Corlett has been critical of the plan to implement work requirements that’s been pushed by Republican state lawmakers and DeWine, and says the state shouldn’t be adding more responsibility into a system that isn’t working right. Corcoran says if she doesn’t have confidence in the system when it’s time to launch work requirements – quoting her here, “then we will pause.”