RALEIGH — The North Carolina agency running Medicaid said Tuesday it should have informed legislators and done a better financial review before accepting a temporary delay from the federal government on changes to recalculate patient eligibility.
The decision by the Division of Medical Assistance in October to accept a three-month wait could cost the state up to $2.8 million, according to the agency, adding the amount could grow if the extension were to be lengthened. The division sought the delay to minimize confusion in determining whether some current Medicaid consumers could keep coverage.
Lawmakers on an oversight committee were unhappy to learn that state health officials knew about the option last summer while developing the state budget, but apparently didn’t alert appropriations committee leaders. At the very least, legislators could have prepared for the loss of funds.
“We had plenty of time to know that this kind of catastrophe ... was hanging over our heads,” Rep. Marilyn Avila, R-Wake, told state Department of Health and Human Services officials during an oversight committee meeting. Legislators, she added, could have found “a way to solve this problem and not make this government look like it’s totally incompetent and does not communicate.”
Department Secretary Dr. Aldona Wos told the legislative panel she was “deeply disappointed that our proper internal organizational process was not followed” on the eligibility decision with the department. She said it had not been shared with top department leaders, so she couldn’t pass it along to legislators last summer: “We apologize to the committee for being in this situation.”
The Center for Medicare and Medicaid Services offered states options to handle new income eligibility standards for current Medicaid consumers taking effect Jan. 1 through the federal health care overhaul. Without the changes, county social service case workers would have had to use two different eligibility standards until April 1, the division said.
“In retrospect, it was the right decision based on where we are right now,” Wos said. Case workers have been handling a backlog of food stamp applications in recent weeks.
About 4,400 individuals a month, mostly children, could be affected by the Medicaid change, acting Medicaid director Sandra Terrell said. Carol Steckel was Medicaid director during last year’s legislative session and left last fall.
The option that North Caroilna accepted meant that people who would have not re-qualified under the new rules will keep coverage through March, while those that get re-evaluated after get 12 months of additional coverage, not six, according to a presentation by the General Assembly’s nonpartisan staff.
The presentation questioned whether the acceptance of the extension violated a new state law requiring public and legislative notice before a waiver to the current Medicaid program is sent to the federal government for approval.
Terrell said the change wasn’t specifically a “waiver,” which usually is time-consuming and undergoes a rigorous review. The three-month extension didn’t require such a submission, she said in prepared remarks.