Tag: State News

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FL has not made it easy for former foster youth to access coverage provided under ACA.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

By Christine Sexton News Service of Florida

March 31, 2021 06:07 PM,

Updated March 31, 2021 07:36 PM

In 2015, County Commissioner Daniella Levine Cava, now county mayor, speaks during the demonstration in support of Florida lawmakers expanding eligibility for Medicaid as called for under the federal Affordable Care Act. The Act established a new Medicaid eligibility category for former foster children to age 26. The state removed 1,730 former foster children from the state’s Medicaid rolls over the past six years in apparent violation of this law. Lynne Sladky AP

TALLAHASSEE

Gov. Ron DeSantis’ administration has quietly backed away from a policy that removed 1,730 former foster children from the state’s Medicaid rolls over the past six years in apparent violation of federal law.

Since January, the Department of Children and Families has waived a state policy that required all former foster children to reapply for Medicaid when they turned age 22, even though they continued to qualify for the program until they were 26 under federal law.

And in what a South Florida legal group called “particularly egregious,” the Medicaid application contained a screening question asking if people were formerly in foster care. If not properly answered, applicants were denied.

Instead of requiring former foster children to reapply for Medicaid when they turn 22, the state has manually entered their information into the system during the past four months, keeping them covered by the healthcare program, according to a document filed by the department in the Legislature and obtained by The News Service of Florida.

Florida Health Justice Project attorney Katy DeBriere told the News Service the move is “a big, positive change for a very vulnerable group of Floridians.”

The move surfaced because the Legislature is tackling thorny issues such as reforming the state’s foster care system and providing access to mental health and substance abuse services.

As part of that, lawmakers are considering a proposal that addresses Medicaid coverage for former foster children, bringing Florida in line with the federal Affordable Care Act.

House approves bill to enroll former foster kids in Medicaid

A House healthcare panel this week voted unanimously to approve a bill (HB 1071) that would require the Department of Children and Families to find former foster children and enroll them in Medicaid. If the state found everyone who was eligible, it would cost an estimated $7.8 million in state and federal money to provide benefits to them.

A legislative analysis of the House bill did not provide an estimate of what the ongoing annual costs of the change would be, just saying the bill would have a “significant, negative recurring fiscal impact to the Medicaid program.”

The bill also would change Florida law to comply with federal law and make clear that former foster children qualify for Medicaid to age 26.

The bill has received near-unanimous support from two House panels. The Senate is considering similar legislation.

The reversal of state Medicaid policy and the proposed legislation came after the Miami-based Florida Health Justice Project sent a demand letter to the DeSantis administration in May 2020 threatening to take the state to court if it didn’t change the policy.

Under Florida law, former foster children qualify for Medicaid benefits up to age 21 under the federal Social Security Act. But the federal Affordable Care Act, better known as Obamacare, established a new Medicaid eligibility category for former foster children to age 26.

Federal law requires states to ensure that people who no longer qualify for Medicaid benefits under one eligibility category are checked to see if they may qualify under a different part of the program before they are removed. The requirement is known as an ex-parte review, and Florida healthcare officials didn’t abide by it, Florida Health Justice Project argued in its letter to the state.

“Given that these youth have been under DCF’s extended supervision, it is presumable that DCF possesses all the information needed to continue Medicaid eligibility for former foster care youth. As such, DCF should simply continue the eligible youth’s Medicaid eligibility …” DeBriere wrote in the letter.

Additionally, DeBriere and other Florida Health Justice Project attorneys said the single question asking whether applicants were formerly in foster care was “particularly egregious” and that it likely violated federal due-process laws.

DeBriere wrote to the state on behalf of a 22-year-old client and former foster child who lost her Medicaid coverage after she turned 21. Without Medicaid, DeBriere wrote, the client “has been unable to access health care services which are particularly critical given her recent release from the (Florida Department of Corrections).”

While the Department of Children and Families maintains that the state policy resulted in 1,730 adults being dropped from the program over the past six years, it is not clear how many former foster children who aged out successfully reapplied to Medicaid.

The Department of Children and Families did not immediately respond to a News Service request for the information.

 
 

Clipped from: https://www.miamiherald.com/news/politics-government/state-politics/article250346316.html

MM Curator summary

Wyoming will now allow schools to bill for Medicaid services.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

CHEYENNE — Senate File 79, known as the Medicaid billing for school-based services bill, was approved by the Wyoming House March 30 and was signed into law by Governor Mark Gordon today.

Last year, Governor Gordon vetoed a similar bill saying that it was “well-intentioned” but “not well-timed”.

The legislation authorizes school districts to bill for school based services for Medicaid eligible students as specified; provides reimbursement to school districts for administrative costs; provides appropriations; authorizes a position; requires reports; and provides for effective dates.

Representatives Chad Banks, D-H17, and Clark Stith, R-H48, both voted in favor of the bill, stating that the bill should help local school districts as well as the state overall.

“The bill should be a win-win all the way around,” Rep. Banks said. “It allows school districts to bill Medicaid for school-based services that qualify. Ultimately it should help our local district and the overall state. Projections are that with in the first year the state will save nearly $400k, increasing to $2.7 million in year three.”

Rep. Stith said as of now, Wyoming is the only state in the country that does not currently ask for Medicaid reimbursement.

“Right now, the school districts provide services to certain special needs students (e.g., speech therapy, physical therapy) for which the federal government would reimburse the schools as a Medicaid eligible service,” Rep. Stith said. “Wyoming is the only state where school districts do not ask for reimbursement. This bill allows school districts to recover those funds from the federal government. The net recovery after all expenses should be about $3 million statewide.”

That bill states that beginning July 1, 2022, each school district with Medicaid eligible students receiving special education programs and services may bill the Wyoming Department of Health (WDH) for the costs of any special education program and service covered under Wyoming statute that is provided to the district’s students.

The WDH will provide payment to each eligible school district that has billed to them as soon as reasonably practical for the costs of approved services.

By September 1 of each school year, each district will have to remit all funds received during the prior school year from the WDH for billed services to the Wyoming Department of Education. WDE will then remit all funds received from the districts to the state treasurer for deposit in the school foundation program account.

The number of Medicaid eligible students receiving special education programs and services for a school year will be determined by the WDE using data from October 1 of the immediately preceding school year.

Services and supplies authorized for medical assistance and Medicaid reimbursement in this bill includes professional services of a school psychologist, and a school social worker.

Also included are school based services delivered pursuant to an individual education program including services provided by an otherwise enrolled Medicaid provider type, provided by a licensed professional in a school setting, or delivery of other special education programs and services.

The director of the WDH, with the consent of the Governor, will be tasked with negotiating with the United States Department of Health and Human Services regarding necessary amendments to the state Medicaid plan and to ensure the necessary services are provided.

The WDH is authorized one full-time position for the purposes of this act. Additionally, the WDH is appropriated $142,622 from the school foundation program account, and the same amount from federal funds to implement this act. Of those funds, no more than $97,660 are to be used for salary and benefits.

 
 

Clipped from: https://www.sweetwaternow.com/governor-signs-school-based-medicaid-bill/

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Virginia no longer requires 10 year work history for immigrants to get Medicaid coverage.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Thanks to a a change that took effect April 1, thousands of Virginians are now eligible. 

RICHMOND – For Sunita Singh, it’s been tough trying to find a health insurance option that will accept her mother. She’s tried for years, with one thing always getting in the way: the10-year-rule for Medicaid. Legal permanent residents in Virginia for decades had to show a 10-year work history in the state to qualify. That all changed on April 1.

“[The 10-year work history ending in Virginia] was really great news because receiving Medicaid will help [my mother] and other permanent residents get access to the healthcare they need,” Singh said. “My mother will be very grateful to receive Medicaid now.”

Thanks to the work of Del. Mark Sickles (D-Fairfax), the General Assembly agreed last year to end the 10-year work history requirement, effective April 1, 2021. That move opened the door for Singh’s mother, and other residents, to receive free or low-cost health coverage.

Jill Hanken serves as the director of Enroll Virginia. That’s a community-based project of the Virginia Poverty Law Center. It provides free assistance with the application and enrollment process for Medicaid, FAMIS and the Affordable Care Act.

Hanken weighed in on the gravity of the change for the immigrant community. She explained why that requirement previously caused issues for some individuals and how the change could help.

A 25-year History

Up until this month, legal permanent residents who lived in America for more than five years had to prove a 40-quarter work history to gain eligibility for Virginia’s Medicaid plan. 

The requirement first arose 25 years ago. In 1996, Congress created a distinction between immigrants who came to the country before welfare reform became law in August.

The reform gave individual states the option to include immigrants already within their boundaries in the state’s Medicaid programs. Virginia put its own spin onto the reform.

“Back in 1996, Virginia had options to choose about how they were going to implement some new federal immigration rules. And they chose to require some immigrants to have a 10-year work history,” Hanken said. “And that 10 years, it’s calculated. You can actually use the work quarters of a spouse or a parent. So it’s not necessarily a full 10 years for one person.”

The Problem 

Even with the option to split the hours amongst family members, the requirement still presented issues. The 10-year work history became an obstacle for many immigrants, but it was nearly impossible for others. 

“It was a result that Virginia selected, but the result of taking that option was a bar to people getting the health services that they needed,” Hanken said. “And for some immigrants who came to the states later in life, they were coming legally to join family members, but there was really no expectation that they were even going to work in the U.S.”

The requirement created an unfortunate issue. Individuals who would normally qualify for Medicaid couldn’t because of a lack of work history. 

“It left people without access to basic health services to services they needed for chronic health conditions, prescription drugs, everything. It basically left too many people in Virginia uninsured. And while they could get help in an emergency, that’s not good medical care in terms of preventive services and addressing ongoing health needs,” Hanken said. “It’s very inadequate. And this population was, for the most part, remaining uninsured, which is a very scary place to be.”

Five-year Requirement Remains 

The adjustment still requires a federally mandated five-year residency requirement for legal permanent residents, or those who hold a green-card. 

In Virginia, the half-decade residency rule applies to most immigrants, but not all. Persons who come into the country as refugees, those seeking asylum, women who are pregnant and children may access Medicaid without the five-year requirement. 

However, healthcare options exist for many immigrants besides Medicaid. And those options become available even before immigrants reach their five-year anniversary in the United States.

“Fortunately [through] the Affordable Care Act, Marketplace is available to immigrants who are legally residing in the United States, even before they meet the five-year limit requirement,” Hanken said.

Helping People

Several populations will see the benefits from the removal of the 10-year work history requirement. One of those individuals will be central Virginia resident Sunita Singh’s mother, who was previously ineligible.

“My mother has been a legal permanent resident for 10 years now and every year we struggle with trying to find a good health insurance for her,” said Sunita Singh, a central Virginia resident. “[The 10-year work history ending in Virginia] was really great news for her because receiving Medicaid will help her and other permanent residents get access to the healthcare they need. My mother will be very grateful to receive Medicaid now.”

Some of the most impacted people will be parents and other adults under the age of 65, disabled people, the elderly over the age of 65 and individuals who require long-term care services. 

“I think it provides a lot of security and peace of mind to a population that’s been hurt in a very obvious way, especially during COVID,” Hanken said. “A lot of immigrant communities have been hit really hard and in a disparate way during the pandemic.” 

Lending a Hand

Signing up for health coverage is the first step. 

“We encourage people to apply today to get very comprehensive healthcare through Medicaid, to really have the peace of mind about access to healthcare,” Hanken said.

Enroll Virginia plans to help individuals throughout the time of transition and beyond.

“Enroll Virginia is a program of [federally and state] certified navigators who are trained to help people understand their healthcare options,” Hanken said. “So we can look at a family’s circumstances and help them understand whether or not they’re going to be eligible for Medicaid or the Marketplace or there’s a program called FAMIS. Or some immigrants may be left with only emergency services. But our navigators understand those options and can help people apply and get enrolled if they qualify for one of those options or understand the alternatives.”

All assistance is free and unbiased and available in a virtual, contact-less setting via Zoom. If an individual is not eligible for Medicaid, Enroll Virginia navigators can help them understand other options for subsidized coverage available to them through the ACA. 

Consumers can contact Enroll Virginia’s staff at 1-888-392-5132. There, they may enter their zip code for a direct transfer to a navigator in their community. Consumers can also visit Enroll Virginia’s website, where they can find a local navigator and schedule an appointment.

Amie Knowles reports for Dogwood. You can reach her at amie@couriernewsroom.com 

 
 

Clipped from: https://vadogwood.com/2021/04/03/whos-eligible-for-medicaid-rule-change-allows-more-virginians-to-sign-up/

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Mississippians look to copy other states and get Medicaid expansion on the ballot.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

After years of partisan fear and loathing and failed attempts in the Legislature, health care and racial justice advocates want Mississippi voters to force the issue and expand Medicaid at the ballot box.

A nonprofit incorporated by the president of the Mississippi Hospital Association and others has filed preliminary paperwork to start ballot Initiative 76, which would put Medicaid expansion in the state constitution, draw down billions of dollars in federal funds and provide health care to potentially hundreds of thousands of working, low-income, uninsured Mississippians.

Mississippi is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of citizens without the ability to afford health care coverage and rejecting at least $1 billion per year in federal funds.

“Hospitals and our working poor across the state of Mississippi cannot keep waiting,” MHA President Tim Moore told Mississippi Today on Monday. “There’s all the federal money we are leaving in D.C., our taxpayer dollars that we need to bring back to help our citizens. We do that with everything else, accept federal help, but for some reason not with this.

“It’s time to let the Mississippi voters decide.”

The planning stages of the ballot initiative signals a broad coalition may be on board with the effort. Corey Wiggins, the executive director of the Mississippi State Conference of the NAACP, has worked closely with Moore and others on launching the initiative.

“Medicaid expansion, which would provide healthcare to over 200,000 Mississippians and bring over a billion dollars in federal funds home to our state, is an issue we’ve encouraged legislators to pass for years,” Wiggins told Mississippi Today.

Moore, Hattiesburg pediatrician Dr. John Gaudet and public health executive and advocate Nakeitra Burse incorporated the Healthcare for Mississippi nonprofit and filed the initial paperwork to try to put the issue before voters. On March 31, the Mississippi secretary of state published an initial ballot title and summary in the Clarion Ledger public notice section. Now, those involved would have to collect about 106,000 signatures of registered voters to put the issue before voters, likely in the 2022 midterm elections.

Moore said the Mississippi Hospital Association will vote on Friday whether to join in the initiative push — very likely given the association’s long-running advocacy of expansion to help save financially ailing hospitals across the state and help the uninsured working poor in the poorest state in the nation. Moore said he hopes numerous other groups that have supported expansion will promptly get on board with the initiative drive.

Many health advocates have pushed for Mississippi to expand Medicaid under the federal Affordable Care Act and draw down billions in federal dollars to a state already heavily reliant on federal spending. The COVID-19 pandemic, in particular, has highlighted health care disparities in the state, which is home to one of the highest percentages of uninsured residents in the nation. Congress further incentivized Mississippi to expand Medicaid in its latest stimulus package, upping the federal match to the 12 states that have resisted expansion.

But state GOP leaders, starting with former Gov. Phil Bryant, have opposed the move, saying they don’t want to help expand “Obamacare” and that they don’t trust the federal government to keep footing the bill, eventually leaving state taxpayers on the hook.

Meanwhile, hospitals — especially smaller rural ones — say they are awash in red ink from providing millions of dollars of care each year to uninsured and unhealthy people in Mississippi.

Current Republican Gov. Tate Reeves has remained steadfastly opposed to expanding Medicaid, as has Republican House Speaker Philip Gunn. Republican Lt. Gov. Delbert Hosemann has said he’s open to discussion on the issue — including last week as the legislature ended its annual session — but expansion has been a nonstarter despite vigorous lobbying efforts by MHA and others.

Just last week, Gunn reiterated his opposition.

“I am not open to Medicaid expansion,” Gunn said. “We cannot afford it, and there are numerous other reasons … Taxpayers cannot afford it.”

Reeves’ office did not immediately respond to a request for comment on Monday.

“Hospitals have tried to work very closely with the state leadership since 2013,” Moore said. “And we have just not been able to move things in that direction. At some point in time you just have to make a decision to move along another avenue.”

Mississippi voters last election took matters in hand on another long-running health care issue, overwhelmingly approving a medical marijuana program by enshrining it in the state constitution. Moore said he believes Medicaid expansion is likewise popular with Mississippi voters.

“If you look at just outside, public polling, you’ve seen numbers approaching 60% just with likely Republican voters,” Moore said.

Moore said the ballot initiative language, if successful, will likely be broad approval of expansion, not a long, detailed directive like medical marijuana, which brought some criticism that it tied state leaders hands in creating an effective, regulated program.

“Health care shouldn’t be in the constitution,” Moore said. “Neither should medical marijuana. That’s not what it’s for. It should have been taken up and dealt with in the Mississippi Legislature. But they did not do that. They didn’t handle it, and so you have to take the next step and put it before voters.”

After Healthcare for Mississippi filed its initial paperwork for the initiative, the state attorney general’s office drafted an initial title and ballot summary for Initiative 76. The group can challenge the wording of the title, which it is doing, Moore and Wiggins said.

The AG’s title draft says “Should Mississippi amend its constitution to require expansion of Medicaid eligibility for people between the ages of 18 and 65?” Moore said this is misleading, and “has no mention of low incomes or working poor.”

Mississippi is one of 12 states that has not expanded Medicaid to provide health coverage for people making up to 133% of the federal poverty level, or about $17,600 a year for an individual. Estimates vary from about 170,000 to 400,000 on how many Mississippians would qualify, with GOP leaders claiming the larger number.

The state would pay 10% of the cost — estimates range from about $75 million to more than $150 million a year — and the feds would cover the rest, estimated at $1 billion a year. The Mississippi Hospital Association has pitched a plan to lawmakers that the state share could be paid by taxes on hospitals and fees paid by the new Medicaid enrollees.

But the American Rescue Plan recently passed by Congress would provide further incentives for states that expand Medicaid, dropping the state’s share of the cost further.

“For a number of years, the federal government has been offering us a $1 million a day to take care of sick people,” Sen. Hob Bryan, D-Amory, chair of Senate Public Health recently said. “Now they are offering $1 million a day to take that other $1 million a day. You can’t make this stuff up.”

Mississippi hospitals are footing the bill for uninsured Mississippians, including about $600 million in uncompensated care in 2019, with costs steadily rising. Advocates of Medicaid expansion say it would not only help save Mississippi’s rural hospitals — many of which have either gone under or teeter on the brink of bankruptcy — but create thousands of jobs and help the state’s economy.

“It’s encouraging to see the conversations around improved access to healthcare in Mississippi,” said Dan Jones, vice chancellor and dean emeritus at the University of Mississippi Medical Center. “Under current conditions, many hardworking Mississippians in jobs without health insurance coverage could gain access to health care only afforded through health insurance coverage. And this can be accomplished in a way to gain substantial economic benefit for our state.”

While supportive of any effort to expand health care in Mississippi, Jones said he believes the best way forward is through lobbying lawmakers, not the ballot initiative process.

“While I appreciate the effort by some to proceed with a ballot initiative regarding Medicaid reform, in my opinion, working directly with our legislative leaders and members is the ideal way to accomplish the goal of increased healthcare access,” he said. “Our legislature changed our state flag when many thought it an impossible political process. I’m confident the same spirit of moving Mississippi and Mississippians forward can result in improved health care access.”

READ MORE: Mississippi missed out on $7 billion when it did not expand Medicaid. Will that figure jump to $20 billion?

 
 

Clipped from: https://mississippitoday.org/2021/04/05/mississippi-medicaid-expansion-ballot-initiative/

 
 

MM Curator summary

MO Medicaid expansion funding was not included in the house appropriations package.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

The Missouri House has passed the next state operating budget – without funding voter-approved Medicaid expansion. The $34.1 billion budget plan is now in the hands of the Republican-controlled Senate. Missouri Senate President Dave Schatz, R-Sullivan, gives his thoughts to Missourinet affiliate KTUI in Sullivan about whether he expects the upper chamber to fund the expansion.

 
 

Missouri Senate President Pro Tem Dave Schatz speaks to Capitol reporters on November 8, 2018 (photo courtesy of Harrison Sweazea at Senate Communications)

“The House chose not to fund it. I think it’s likely that the Senate does not put it in the budget as far as funding Medicaid and it will be up to, at that point, to see what the courts say. I believe we have the Constitutional grounds to stand behind the decisions because we are the appropriators of money. We’ll see where it goes,” Schatz tells KTUI. “But I think, again, it’ll remain up to the will of the Senate of the 34 members as to whether or not we do put it in. If some sort of funding mechanism goes in there, then obviously the House and Senate would have to get together, conference on that item and see if there’s a compromise there in order to do it. But I mean it’s likely right now if the House didn’t send it over in there, I believe it’s likely that the Senate, it’s probably not in there as well.”

Last August, 53% of Missouri voters approved providing government-funded health care coverage to about 275,000 low-income adults, although it failed in 105 of the state’s 114 counties.

Under the expansion, 90% of the funding comes from the federal government. Missouri picks up the rest of the tab.

“The one thing that it did not include in it was a funding mechanism,” says Schatz. “Therefore, obviously all it did was expand the Medicaid population to 138% of the poverty level. I truly believe, had there been something in there that said, ‘Oh and by the way, we are going to increase this tax or that tax in order to pay for this program,’ I don’t think that measure passes.”

Gov. Mike Parson, a fellow Republican, requested $1.9 billion to fund the expansion set to begin in July. Parson did not back the expansion ballot measure but has said he will implement it. Here is what Parson has to say about the GOP-controlled House’s effort.

“We’ll have to see how that goes in the Senate there. We did put the money in the budget for that. People did vote for it. Although I didn’t support it (expansion) at the time but the reality of it is, the people of the state voted for it. I thought it was my obligation as governor to make sure we try to get it implemented,” Parson tells Missourinet affiliate KDRO in Sedalia. “We’ll see though. The House voted against that – a little different maneuver I want to say, I guess. We’ll see what the Senate does and we’ll see how it comes out at the end of the day.”

The Legislature could choose to use the governor’s request for the expansion to instead help seniors in nursing homes, the developmentally disabled, expand mental health programs, add more public defenders, and for K-12 public school transportation costs.

In excerpts from a statement from Missouri House Minority Leader Crystal Quade, D-Springfield, she says Republicans need to stop with the political grandstanding and games.

“The only thing House Republicans have done is declare they would rather bankrupt the state Medicaid program than respect the clear will of the voters and fulfill their most basic oath to follow the constitution. They would rather cling to extreme partisan dogma that holds our state back than accept the tremendous economic and public health benefits expansion will provide. This fight is so unnecessary and little more than a destructive temper tantrum by petulant children who didn’t get their way,” says Quade. “So, after expansion takes effect three months from now and more Missourians enroll, the program at some point will run out of spending authority if House Republicans are successful in defunding Medicaid in the final state budget. That will require the legislature to return for a costly special session to pass a supplemental budget bill to fund Medicaid for the full year. And if Republicans refuse to provide full funding in a supplemental, then the battle will shift to the judicial branch, where it inevitably ends with a court ordering Republicans to comply with the constitution. Every medical organization and patient advocacy group in the state supports expansion. Even the Missouri Chamber of Commerce – as Republican of a group as there is – supports expansion.”

The state Constitution requires the Missouri Legislature to approve a balanced budget by early May.

Clipped from: https://www.missourinet.com/2021/04/02/will-the-missouri-senate-back-the-houses-effort-to-defund-medicaid-expansion-senate-leader-weighs-in/

MM Curator summary

 
 

In the latest of several years of audits finding issues with the Minnesota HHS department, findings show a lack of oversight and required skills in the administration of $134M in MH and SUD grant funds.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Human Services Commissioner Jodi Harpstead addressed members of the Legislative Audit Commission in 2019 over regulatory breakdowns that led to overpayments to Indian tribes and counties.

For nearly three years, the Minnesota Department of Human Services (DHS) doled out tens of millions of dollars in grants for mental health and substance abuse services without providing adequate oversight over the grant-making process, according to a state Legislative Auditor report released Monday.

The audit by the state’s top internal watchdog found extensive mismanagement and violations of state legal requirements in the handling of grants awarded by the department’s Behavioral Health Division, which has a staff of 140 and made grant expenditures of about $134 million in fiscal year 2019.

The 56-page report by the Office of the Legislative Auditor, a nonpartisan arm of the Legislature, concluded that the Behavioral Health Division’s grant-making process failed to comply with a “significant number” of state policy and legal requirements, and did not ensure that employees had the appropriate skills, knowledge and job descriptions to manage grants in compliance with state and federal requirements.

The division also did not follow state rules and policies to document potential conflicts of interest, according to the report. The audit was focused on grants and payments made between July 2017 through March 2020.

The Legislative Auditor’s office “found that internal controls over the areas in our audit scope were not adequate to ensure that DHS, through its Behavioral Health Division, safeguarded assets and ensured compliance with legal requirements and state policies related to grant oversight,” the report states. In some cases, division supervisors assigned grants to staff who lacked grant management training and experience or staff whose job duties did not explicitly describe duties and tasks related to managing grants, the auditor found.

The findings reflect long-standing problems within the DHS Behavioral Health Division, and come as Human Services Commissioner Jodi Harpstead is working to strengthen internal controls and restore public trust in the massive social service agency, which has a $21 billion budget and oversees public health insurance programs for 1.1  million Minnesotans.

 
 

Human Services Commissioner Jodi Harpstead addressed members of the Legislative Audit Commission in 2019 over regulatory breakdowns that led to overpayments to Indian tribes and counties.

In an interview Monday, Harpstead and DHS Compliance Officer Shireen Gandhi said the agency was already aware of management problems with the Behavioral Health Division and began to address them early last year through a series of process improvements, including an overhaul of the division’s grants-management approval process and new training to ensure that all grants and contracts within the division are properly documented.

The division is also rolling out an automated system for tracking and reporting on grant management activities, which should help standardize procedures, they said.

“After my first 90 days as commissioner, I said that some areas of DHS are soft around the edges and we need to work on crossing the t’s and dotting the i’s,” said Harpstead, the former head of Lutheran Social Service of Minnesota. “We’ve spent the past year working intensely on evaluating our processes and putting the pieces in place to start implementing changes.”

The audit found 14 areas within the Behavioral Health Division where internal controls were inadequate or failed to comply with state legal requirements. While arcane, the internal controls are significant because they are the nuts-and-bolts procedures that govern how an agency performs its work and makes key decisions, like how to disburse funds or evaluate who is best qualified to receive a grant.

The DHS is still trying to recover from revelations nearly 18 months ago that it made more than $100 million in unauthorized Medicaid payments to Indian tribes and counties for substance-use treatment services, which had to be repaid to the federal government.

A 2019 review by the Legislative Auditor found “troubling dysfunction” at DHS, including instances in which individuals were allowed to make decisions to spend Medicaid funds without review and approval from department officials responsible for the state’s Medicaid program.

“Every time an audit comes out, DHS insists that the issues have been addressed, yet every time the [Legislative Auditor] seems to uncover new problems,” said Rep. Tony Albright, R-Prior Lake, a member of the House Human Services Finance and Policy Committee, in a written statement. “We need real reform and real accountability, not more excuses, slogans, and window dressing.”

Since taking the helm of the DHS in August 2019, Harpstead has rolled out a series of process-control improvements that have drawn praise from lawmakers and put the department on sounder financial footing. Those measures include centralizing financial decisionmaking and compliance, identifying gaps in grant-making processes, and convening quarterly leadership meetings on compliance and risk mitigation strategies.

DHS also has established clearer lines of communication between its division leadership and officials responsible for the state’s Medicaid program, to prevent the sort of costly missteps that occurred in 2019.

The agency has repaid the federal government $103 million in Medicaid overpayments to Indian tribes and counties, and completed a review that found no further payment errors in 2020.

“I would say we’re in the second inning of a nine-inning ballgame,” Harpstead said of the process-control improvements. “It’s not all fixed and behind us. It’s all figured out. And we know what to fix and we’re working through the steps to fix it.”

Chris Serres • 612-673-4308

Twitter: @chrisserres

 
 

Clipped from: https://www.startribune.com/legislative-auditor-finds-shoddy-oversight-of-grants-at-minesota-department-of-human-services/600039865/

 
 

 
 

MM Curator summary

 
 

Kariuki Kimungi settled the Medicaid home health fraud charges against his firm.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Massachusetts Attorney General Maura Healey disclosed earlier this month that her office has reached a $1.25 million settlement with Lawrence, MA-based Lifod Home Health Care LLC and its owner, Kariuki Kimungu, to resolve allegations that they billed the state’s Medicaid program, MassHealth, for unauthorized home health services.  

“This kind of illegal conduct takes funds away from MassHealth, which provides critical health care services to low-income and vulnerable residents across the state,” Healey said. “We are committed to combating fraud, waste, and abuse in the home health industry and will continue to take action against companies that don’t abide by state laws and regulations.”

The settlement also requires Lifod to operate under a multiyear compliance program with updated policies and procedures, new training for staff, and yearly audits conducted by an independent compliance reviewer. 

 
 

Clipped from: https://www.mcknightsseniorliving.com/home/news/home-care-daily-news/massachusetts-home-care-company-pays-1-25m-for-alleged-medicaid-fraud/

 
 

 
 

MM Curator summary

 
 

Efforts to increase governance on payments in the “personal care services” benefit in NY Medicaid have met opposition.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

ALBANY — Under a policy pushed by Gov. Andrew M. Cuomo, the administration of a popular program that allows Medicaid recipients to receive at-home health care for loved ones was interrupted for more than 100,000 New Yorkers.

Now, Democrats in the Legislature are pushing for a delay in that policy’s implementation through negotiations over the state budget.

The Consumer Directed Personal Assistance Program (CDPAP) is a state-run program paid for through federal Medicaid funds. It allows people to pay for at-home health care service through a middleman known as a “Financial Intermediary” (FI), rather than sending the person in need of care to a dedicated facility. The FI handles the payment and logistics of the arrangement.

CDPAP also allows people in the program to choose the person who will be providing care. For instance, Patience Gabbidon, 19, lives in the Capital Region and is paid $12.50 an hour to care for her grandmother, who has diabetes and chronic issues with her eyesight. Gabbidon said she cleans her grandmother’s house, runs errands for her, checks her blood sugar and makes sure she takes her medication on time.

“She’s getting older now and it’s getting harder for her to move or get outside, and she gets tired — so I help her around the house,” Gabbidon said.

In a February budget hearing before the Legislature, a staffer from the state Health Department said 139,000 New Yorkers use the program.

“Patients who might have refused home health care because they don’t want some stranger in their home are much more willing to use the consumer-directed program,” said Richard Gottfried, chair of the Assembly Health Committee. “The state health department has tried through a variety of efforts to dramatically cut down on the program.”

Cuomo asked for and was given authority as part of the 2019 budget negotiation to exercise tighter state oversight of FIs. His administration’s argument is that this ensures rules are followed, waste is reduced, and the program is better monitored overall.

“What the health department hates about the consumer-directed program is precisely that it is very popular,” Gottfried said, adding that Cuomo would like to cut costs and exert more control over CDPAP.

DOH now requires FIs to reapply for the program, which led to a culling of their number from more than 450 to 68, according to Jonah Bruno, an agency spokesman — a reduction of more than 80 percent. Without an FI, people could lose service. Bruno said the FIs that have now been vetted by the health department “will be able to ensure consumer choice and access in each county across the state.”

In the February hearing, Assemblywoman Pam Hunter said that in Onondaga County — with a population higher than 350,000 — there was not a single FI awarded. She said while there had been a measure of waste and abuse among the FIs, “it makes no sense” to have zero in the whole county.

“So many of the organizations, the not-for-profits that have provided this crucial service to many of our most vulnerable … were not rewarded,” Hunter said.

Other lawmakers expressed concerns that the process for deciding who could remain as FIs was opaque and too restrictive. Under a standalone bill pushed by Gottfried, the full 450 previously approved FIs would be able to continue through 2022, while those that applied to DOH and were denied would be reconsidered.

This delay was also included in the state Senate’s proposal for the budget, staking out that chamber’s negotiating position. A letter sent last week, signed by 59 Democrats in the Assembly, called for the delays to be supported by that chamber as well.

“The governor’s people have been resisting what we’re trying to do,” Gottfried said. “Without going into details partly, because they change practically by the hour, there is some openness on the governor’s side to reexamining, to doing something like what legislators have been advocating.”

The ostensible deadline for the state to pass a budget is Wednesday.

 
 

Clipped from: https://www.timesunion.com/news/article/Legislature-pushes-back-on-Cuomo-policy-to-16061369.php