Let's make DHHS accountable for Medicaid
Published April 27, 2014
by Representative Andy Wells, published in Charlotte Observer, April 26, 2014.
From N.C. District 96 Rep. Andy Wells, a Republican from Hickory who is running unopposed for the N.C. Senate District 42 seat:
Medicaid is the biggest, fastest growing program in state government – and the only program with no budget. That’s not to say the department in charge of it doesn’t crunch numbers and set targets and pretend to have a budget, but the hard fact is the numbers are illusions. When the end of each fiscal year rolls around, with red ink piling up, the Department of Health and Human Services lands on legislators’ doorsteps saying, “We’re back for our annual bailout.”
No one would run a business that way. No one would say to a manager, “Here’s your budget but don’t worry if you spend too much – we’ll write you another check.”
But that’s happened over and over with DHHS – which may lead to a second mistake: Frustrated legislators may decide to fix DHHS’ bungling by managing Medicaid themselves.
Now, I’ll grant you, that’s a temptation. But a legislator would be better off taking title to a local coal ash pond than taking ownership of Medicaid.
So, what’s the alternative?
How about this: Let’s set a real Medicaid budget that includes a hard cap on spending – then tell DHHS, “Don’t even think of coming back at the end of the year for more.”
Let’s also give the governor the power to do whatever it takes to stay under that spending cap, including the authority to cut the number of people receiving Medicaid, to cut programs, and to cut fees to providers. The bottom line’s the same: Legislators aren’t giving DHHS one penny more.
And while we’re at it, let’s give the governor and Secretary Aldona Wos the power to tackle Medicaid waste and fraud. Right now, if North Carolina slips up and wastes (or gets flim-flammed out of), say, $100 million in Medicaid funds, we have to repay roughly $65 million to Washington. In other words, North Carolina has to repay Washington for Washington’s share of the wasted money.
Now, in practice, that sounds fair. But in the real world it’s led to one odd consequence: No one at DHHS is on fire to identify Medicaid waste and fraud.
So, let’s give Secretary Wos the green light to negotiate a pilot “Fraud Elimination Program” with Washington. The secretary could ask our congressional delegation to sponsor legislation to waive the refund requirement to allow her to cut every penny of waste she can find.
When it comes to fixing Medicaid the cure isn’t the legislature stepping in and doing DHHS’ job – it’s good old-fashioned accountability.
For years, legislators have given DHHS billions then, every time they’ve screwed up, we’ve bailed them out. That’s not accountability.
So instead of continuing the bailouts, let’s say: “Here’s a budget. Here’s a hard cap. And here’s the power to stay under that cap. Now go do your job. And don’t even dream of coming back for more money.”
April 27, 2014 at 10:31 am
Bobby Poon says:
This indicates a lack of understanding of the medicaid system.The feds control the system.The real problem is going to be the full implementation of Obamacare and the ADA(Adults with Disabilities Act) which both combined is going to increase the medicaid rolls by around 1,000,000 more recipients.The ADA has wound its way through court and has now landed fully on NC and NC as capitulated.Medicaid is the worst paying, to providers, in terms of reimbursement for services so that most medical professionals will not even accept medicaid patients.Hospitals actually lose millions accepting medicaid payments because the medicaid fees are too low.I don't know of any or very many dentist that accept medicaid in NC.Its not DHHS that is broken its the entire systemfrom top to bottom.It is a train wreck that no amount of money can fix.The ADA act is having NC place mentally ill in private apartments or homes with round the clock government care that will cost at least $25,000 per month tax payer expense and medicaid will have to pay that.Someone will have to prepare their meals,dispense meds,give mental evaluations and care,drive to shopping,buy their clothes,all daily living etc and at tax payer expense.All in their own private apartment or home that the taxpayer must pay for.Because the fed government as said NC must do this and NC legislature as agreed and Mr Wells is one of those who agreed.Those folks were in assisted living homes paying $1800 per month receiving all of those services but now the law says they cannot stay there.And ,you may not know this,but Mr.Wells and the legislature has approved employees,one who makes $250k per yr,that travel to assisted living homes and interview residents and if they think they should be moved to a private apartment or private home of their own,then out they go at taxpayer expense.And all the services they received at the assisted living home are then received but at much higher cost to the NC taxpayer.My estimation is it will cost at least $25,000 per month per person.I think this is low because now all the services will be by government employees instead of a private assisted living company.Check it out for yourselves.Ask DHHS about the ADA act and what is happening in NC with its full implementation.The legilators love to beat up on DHHS because they have no understanding of its complexity and the monster they have creted.It is their fault.Don't you let them forget it.Especially Mr. Wells who seems to want to demigod.
April 27, 2014 at 6:15 pm
Richard Bunce says:
A well run government program... never gonna get it. End Medicaid and everyone can be pooled in the Marketplace after the ACA is amended to remove the income floor on the Federal income tax credit/subsidy put in place by the Democratic majority in Congress when they passed the ACA.
