Medicaid Hidey Holes

The Medicaid Delivery System is a bureaucracy within a bureaucracy. The root word, “bureau,” is French in origin and refers to a desk with many drawers. The suffix, from the Greek, “-kratia,” or “-kratos,” means “power” or “rule.” Literally, then, the word “bureaucracy” would mean “many drawers (offices) ruling.”

Medicare is a federal health insurance program for people age 65 or older, or for individuals with disabilities. Medicare is entirely federally funded.

Medicaid is a program sponsored by the federal government and jointly funded by the federal government and states. It is managed and delivered by the individual states, and provides health care and health-related services to low-income individuals. Medicaid is the largest source of funding for the poor, including families, the frail and elderly and the disabled.

In other words, Medicaid is supposed to be help for the elderly poor, the disabled poor, and families who live at below poverty level. Unfortunately, the “drawers” in this bureaucracy are really “hidey-holes” for mistakes, unduly large salaries and misappropriated money. The very fact that individual states are in charge of Medicaid funding distribution creates even more hidey-holes. In relegating this chore to individual states, even more hidey-holes are created. Hole upon hole for funds to drift down –

Despite what one may hear, there is plenty of Medicaid money. This money is taken down such a maze in its delivery for Medicaid services, that it somehow gets lost or gets to someplace it was never meant to go.

Does the federal government wish to negate its responsibility to the poor and needy by passing it on to the states? Why can’t Medicaid services be delivered by the same pipeline which delivers Medicare? The current method of “partnership” with the states in the delivery of Medicaid services (funding) is a mistake of catastrophic proportions. Why add more hidey-holes? Real flesh and blood people need these funds; these funds should come to them in the most direct manner possible.

Unreported overpayments to a state or a state’s contractors are common. Unreported under-service to Medicaid recipients is even more common.

The Washington Post reports on July 20, 2007, that the District of Columbia wasted nearly $100 million dollars over the past five years by overpaying Medicaid health care contractors for services that Medicaid patients did not receive.

Washington Post reporter Yolanda Woodlee writes that “Auditors found three contractors – Amerigroup Maryland, D.C. Chartered Health Plan and Health Right – that coordinate medical services for about 90,000 poor people, had received a total of $96.6 million in “excess payments.”

States do not always comply with the commitments they made when accepting taxpayers’ dollars. For Example, facing less Medicaid funds in 2004, Kentucky cut off Medicaid for 3,000 elderly and disabled individuals in Long Term Care, in violation of federal Medicaid law making nursing care a mandatory service. Vada Kerr was 93 years old when she was told she was losing Medicaid funding for the nursing home where she lived; she was a double amputee and suffered from congestive heart failure. Flora Marie Hobbs, 83, could barely walk, fell often, and had dementia. Other individuals lost Medicaid funding for nursing homes where they had lived for years. Kerr and others filed a class action to force Kentucky to comply with federal law.

Kentucky argued that the Medicare Act was not enforceable by individuals. The state claimed that the only remedy was for the federal government to terminate Medicaid funding to the entire state.

The district judge disagreed, found that Kentucky had violated federal law, and entered a preliminary injunction. The state then agreed to settle the case. The settlement came too late for Mary Gerton, 79, who fell alone at home and died shortly after the state had cut off her Long Term Care. Vada Kerr also passed away within a few months of filing the lawsuit, but thousands of other elderly and disabled individuals were able to retain the critical Long Term Care services required by federal law.

If the federal government continues to allow states’ control over distribution of Medicaid funding, uniform enforceable guidelines, written in stone, should be put in place for the distribution of Medicaid funds. Audits and oversight by the federal government should not be intermittent, but ongoing, with a federal auditor in place at every funds distribution point.

Too many people are making too much money taking money that should travel down a straight pipe to its recipients – the elderly and disabled poor.

Okay, all you guv’ment bureaucrats. Here’s the plan to get the money for Aunt Susie’s Medicaid service directly to the folks who perform those services for Aunt Susie without paying for the toll road:

Each doctor’s office will hire one or more Medicaid coordinators, depending upon the size of the Medicare/Medicaid practice the doctor has. The coordinators will be paid out of the doctor’s pocket (isn’t that a novel idea?) because he will be making money on the Medicare services performed by his office.

The duties of the Medicaid coordinator(s) will be to liaison with the physician, the patient and Medicaid, assessing the Medicaid needs of the patient and obtaining them per doctor’s orders, or social assessment. For example: Aunt Susie is preparing to be discharged from the hospital. The Medicaid coordinator from her own doctor’s office
orders for Aunt Susie: Visits from a Home Health Nurse (Medicare paid), a bedside commode (Medicaid paid – DME), a wheelchair to help get Aunt Susie to her doctor’s appointments (Medicaid paid), Oxygen (Medicaid paid) and four hours per day of non-skilled caregiving to prepare Aunt Susie’s meals, help with personal hygiene and straighten up the house (Medicaid paid).

The DME company, the O2 company and the non-skilled care company all bill Medicaid directly without the use of a third party, just like the Home Health company bills Medicare for its Home Health Nurse.

Simple? Frighteningly so.

Arizona Health Care Cost Containment Systems (AHCCCS) and Arizona Long-Term Care (ALTCs) need to be thrown in the trash can. AHCCCS was supposed to be an “experimental program.” Hey, Medicaid!!! Guess What? The experiment failed. All the lab rats died. The only things left are the big fat rats, so we need to bring in a very large cat.