N&O article re: 75M Medicaid Budget Shortfall

Medicaid budget to come up $75M short
Published Fri, Jun 15, 2012 07:45 PM
By Lynn Bonner - lbonner@newsobserver.com
Published in: State

[ Original News and Observer article here ]

Legislators learned this week that the Medicaid budget would show a bigger than expected shortfall this year, just weeks after they passed a law they thought would solve the problem.

Medicaid claims paid June 12 were much higher than expected, said Al Delia, state Department of Health and Human Services acting secretary, costing the state about $25 million more than anticipated. The state has to pay two more rounds of Medicaid provider claims before the fiscal year ends, leading the office to project that the Medicaid budget will come up about $75 million short. Claims were higher than expected in the previous two payment cycles as well, Delia said, but the increases were smaller. Legislators were kept apprised of the increases and were told this week of the trend, Delia said.

Medicaid is the biggest wildcard in the state budget, with costs for the government insurance for the poor and disabled routinely higher than projected. The legislature a few weeks ago passed a law to fill a $205 million Medicaid budget shortfall for this year.

Delia said health-care provider claims tend to dip at this time of year, so the increase surprised Medicaid and state budget officials. The uptick resulted from providers filing claims at a faster clip, Delia said. The bills can be covered with temporary transfers from other state accounts, he said.

“Providers will be paid,” Delia said. “Services will continue.”

State Rep. Nelson Dollar said legislators are ready to work with state administrators to solve what he called a “cash flow problem.”

“They may need to move funds from one area of the budget to another so they can pay those obligations in the current fiscal year,” said Dollar, a Cary Republican.

Legislators asked state administrators to investigate the cause of the higher claims, Dollar said, but they do not think this month’s spike in bills portends higher than anticipated costs next year.

Bonner: 919-829-482

email from Dr. Pat Porter

09 April 2012

Received via email from Dr. Pat Porter, DHHS consultant to the NC General Assembly:

Hello Crystal, I followed up on your question regarding the rates of pay for direct care workers per the changes in approved service definitions.  While this seems to be resolved for now, there were a couple of issues that caused some confusion with the transition of ECBH to the B-C Innovations Waiver.

The CAP IDD waiver is not a perfect crosswalk to the Innovations waiver.  In the CAP Waiver, recipients have had access to Home and Community Support (HCS), which is primarily a habilitative  service with a very small amount of personal care (PCS) blended in.  (CAP IDD also has the basic PCS).  So, HCS in CAP cross-walks to In-home Skill Building and PCS in the Innovations waiver.   In-Home Skill Building (a hab service) pays more than PCS.

As ECBH was cross-walking the services during transition, they cross-walked much of the HCS to PCS, rather than In-Home Skill Bldg.   Again, HCS/In-Home Skill Bldg. pays a higher rate than PCS.  But, there was a reason for this. ECBH could find very few habilitation  goals on the plans being reviewed and, unfortunately,  they found little or no evidence of assessments supporting the recipient's ability to benefit from habilitation.  Based on the assessment information they found, it appeared that most recipients were actually receiving more PCS than hab. As you know, the Managed Care sites  must pay for the actual services needed and rendered.

With further review and technical assistance from the Division of Medical Assistance,  ECBH elected that the wisest course of action on behalf of their consumers would be to cross-walk HCS directly to In-Home Skill Bldg for ease of transition.  I am told that these cross-walked plans will last for the remainder of the plan year.  This is the action that had already been taken by Western Highlands and PBH as they made these transitions.  I am told that ECBH alerted the providers in a March 22 Communication and in a town-hall meeting in Greenville but, apparently, not everyone has gotten the word yet.

At some point soon, ECBH will be compelled to address the  habilitation/PCS issue. Perhaps this will occur in Annual Revisions. Care Coordinators have been alerted to pay attention to additional assessments that may be needed to support habilitation goals.  Be assured that the Care Coordinators will develop plans based on what the recipient needs and wants ( that’s the rule). Utilization Management may, however, deny a habilitation service if there is not demonstrated medical necessity per CMS rules.  Certainly, if that should occur, ECBH will offer review and appeal rights. The DHHS will be monitoring the process to assure due process.

This is a long reply but I hope it is helpful to you