Computer problem extended MaineCare payments to ineligible recipients; budget figures in doubt

Posted March 06, 2012, at 7:42 p.m.
Mary Mayhew
Pat Wellenbach | AP
Mary Mayhew

AUGUSTA, Maine – A computer problem that allowed at least 19,000 Mainers who were not eligible for Medicaid to receive benefits has thrown state budget assumptions into doubt and may extend the current legislative session while the situation is addressed, state officials said Tuesday.

“We had people who were no longer eligible for MaineCare that were continuing to be covered,” Health and Human Services Commissioner Mary Mayhew said. “We are doing an analysis to find what the financial implications are.”

Mayhew and Gov. Paul LePage met with legislative leaders and members of the Appropriations Committee on Tuesday afternoon to inform them of the problem with the billing for MaineCare, the state’s name for Medicaid.

Mayhew said staff at the Department of Health and Human Services were aware of a problem with the bill-paying computer system since 2010 but it was not brought to the attention of her and other agency leaders until January. She did not know how long the ineligible people received the benefits.

Basically, she said, the bill paying computer system could not communicate with the eligibility system, so individuals were not being removed from the billing system after it was determined they were no longer eligible for benefits.

“We have two information systems that were never designed to talk to one another, and so these cases were not properly closed in the claims payment system,” Mayhew said.

She said the agency is looking back through its records to uncover if there are more cases where persons became ineligible but the information never got into the bill paying system.

“We need to do a system-level comprehensive analysis of what else should we be looking at within this system that is affecting our data, the integrity of our data and our ability to make informed decisions about this program,” Mayhew said.

She said there is no estimate yet of what this problem means to the Appropriations Committee that is working on a Medicaid budget bill for the second year of the two-year budget. Lawmakers recently approved an emergency budget bill of $120 million for MaineCare this year.

Mayhew said it is likely there are some additional costs in the current budget year, but removal of all of those persons ineligible for coverage should reduce the expected costs of the program in the second year. She said it will take four weeks to do the analysis and provide dollar amounts to lawmakers.

Leaders and members of the Appropriations Committee were surprised and upset at the problem. Leaders had hoped to end this session in the first week in April.

“It’s obviously enormously frustrating to have this computer problem still haunting us,” said Senate President Kevin Raye, R-Perry. “The whole thing with the computer system is just a nightmare from which we are yet to awaken.”

He said it is unbelievable that the computer problems at DHHS continue. He said legislative leaders will be meeting over the next few days “to get our arms around the magnitude of this” and what its implications are for the session. He said it could have an impact on the timing of the session, but refused to speculate on the length of any delay in ending the session.

Rep. Peggy Rotundo, D-Lewiston, the Democratic lead on the Committee, said it will have an impact. She said the panel cannot complete work on a state budget without numbers they can believe are accurate.

“The magnitude of that incompetence is astounding to me,” she said. “One of the things that is particularly disturbing to me is that someone in DHHS knew in January that there was a problem. This is at the same time we were meeting with the commissioner and her staff trying to figure out why we had a shortfall.”

Rotundo said all through the negotiations on the Medicaid budget for 2012 there were questions about the projections from DHHS and that some figures “just didn’t add up,” but they were never told of any problems with the computer systems, although Mayhew knew at that point.

“As commissioner I own responsibility for this problem,” Mayhew said. “This issue should have been identified and brought to my attention.”

She said there will be “accountability” for the problems within her staff and the failure to inform her and the Legislature of the problem. She said she is bringing in help from the state Office of Information Technology and the State Controller’s office to help in the analysis.

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