Blunt considering Medicaid overhaul

Reports say problems allow the program to misspend tax dollars.
Tuesday, December 7, 2004 | 12:00 a.m. CST; updated 3:45 a.m. CDT, Monday, July 14, 2008

JEFFERSON CITY — A reorganization of Missouri’s Medicaid system must be seriously considered given recent reports criticizing its management, a spokesman for Gov.-elect Matt Blunt said Monday.

While no specific proposals have been developed, Blunt spokesman Paul Sloca said Blunt’s transition team has been looking at ways to improve Missouri’s government, including overhauling Medicaid.

“There are some concerns raised by the oversight committee, and the governor is committed to looking at those issues,” Sloca said. “There are no plans on the table right now, but we have to look at those concerns and take a thoughtful approach to improve the system.”

Inadequate computer systems, poor organization and mistakes by staffers have allowed Medicaid to misspend tax dollars, according to two reports issued Monday by the Committee on Legislative Research. Committee investigators found the state’s failure to adequately review the eligibility of Medicaid recipients has allowed unqualified people to receive aid.

The Division of Medical Services of the Department of Social Services oversees Medicaid, a joint federal-state program that provides medical care to poor citizens. According to state records, more than 980,000 people receive benefits.

House Speaker Rod Jetton, R-Marble Hill, chairs the committee that issued the report. Jetton led the charge to roll back Medicaid entitlements in the last legislative session.

The report reviewed active state employees on Medicaid and found 325 who received aid while they were drawing benefits from the health-insurance program provided for state employees. The report says there might be some cases where the payout was warranted but notes that the duplication has cost the state $1.84 million.

The committee also reported that an evaluation of 125 case files discovered a failure to detect applications with outdated information or fraudulent financial statements. Investigators found some Medicaid recipients with home addresses, and sometimes jobs, in other states.

Understaffing and poor training in the social services department, along with a lack of rigorous investigation and poor money management in Attorney General Jay Nixon’s office are to blame, according to the report.

Social Services Director Christine Rackers thought the critique was helpful but said she saw no easy way to eliminate fraud and error in a program as large as Medicaid.

“When you drill down to the nuts and bolts, you see there’s not one single answer,” Rackers said. “There’s not one corrective action. Instead, it takes constant vigilance to all processes.”

Nixon praised the oversight committee’s efforts in a written statement. A memo attached to his statement, however, disputes the claim that his department failed to fully apply for federal matching funds. It concedes that Nixon’s Medicaid fraud investigators overpaid nearly $40,000 that could have been drawn from federal coffers but questions the $125,000 figure laid out by the committee. The memo claims his office is trying to regain the money.

Nixon’s response goes on to cite the complexity of Medicaid fraud — which often crosses jurisdictional lines both inside and outside of Missouri’s borders — as an obstacle to success. It adds that the Attorney General’s Office has recently hired three new workers and suggests boosting Nixon’s power to press charges would increase the number of recoveries and convictions.

Nixon spokesman Jim Gardner downplayed the financial miscues and instead pointed to the success of the office’s fraud-recovery unit, which has reclaimed more than eight times as much money as its counterparts in Iowa and Illinois.

The oversight committee’s report echoes an April report from the office of State Auditor Claire McCaskill, which found problems in how Medicaid caseworkers evaluate eligibility requirements. Her report claimed to have found 1,112 Medicaid recipients who were sent a combined $144,000 after their deaths.

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