Medicaid needs 'scrubbing'

An initial audit of Medicaid spending shows widespread abuse of taxpayer dollars.

Here's what passes as reform in Illinois.

Last summer, Gov. Pat Quinn and state legislators reached a negotiated agreement on a series of changes to Illinois' hugely expensive Medicaid program that were estimated to save $1.6 billion.

Among the proposals to cut unnecessary costs and clean up Medicaid was a simple idea: remove those people ineligible for benefits by virtue of their income (too high to qualify) or their residence (they live outside the state).

That enforcing those common-sense requirements would be deemed a major reform is astounding by itself. But the results of the so-called "scrubbing" process are even more so — auditors found that 13,709 of the first 20,500 recipients whose status was reviewed were ineligible for state benefits.

Medicaid is a huge state program. One of every five people are enrolled. Its cost, along with that of public pensions, is bankrupting the state. With a planned Medicaid expansion under the Affordable Care Act, those costs will continue to increase, even though federal officials say they will pick up much of the new costs for several years.

But because of Medicaid's costs, it's hard to imagine the program's administrators wouldn't constantly be reviewing the rolls to see that only those who actually qualify receive benefits. That would appear not to be the case.

Julie Hamos, who oversees Medicaid as the chief of the Illinois Department of Healthcare and Family Services, defended her department's oversight of Medicaid. She told The Chicago Tribune that those who were found ineligible had been flagged as suspicious by her department.

That's hardly reassuring. It takes more than flagging suspected fraud to eliminate it. It takes sharp-eyed managers aggressively doing their job, something the state apparently has been lacking.

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Sid Saltfork wrote on April 11, 2013 at 3:04 pm

One news article today indicates that the Dept. of Human Services is woefully understaffed with some caseworkers handling 2,600 cases.  The same applies with the vast majority of state agencies.  Services have slowed down due to less employees.  The conservative media has howled for pension theft, and reduction in state employment in past articles.  Now, it complains about the lack of "sharp-eyed managers aggressively doing their job".  

Oh well, it has to be someone else's fault.  It must be the employees fault.  Their pensions are being stolen.  The new hires will have to work until age 67 with hopes that their pensions will not be stolen.  Young people are not interested in working for a devious employer.  Recruiting state employees is starting to show dismal results.  Yet according to the conservative media, the current workers are not "aggressively doing their job".