A panel tasked with finding ways to root out fraud and abuse in Louisiana’s Medicaid health care program will likely continue its work for at least another year.
The Legislature-created Medicaid task force, formally known as the Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives, has spent the past several months discussing concerns about abuse and waste within the largely federally-funded but state administered health care program for the poor.
“I think it’s opened up some eyes about what we can do when we all work together and share information,” said Rep. Tony Bacala, a Prairieville Republican and member of the task force who said he’ll sponsor the legislation to keep the group going past its expiration June 30.
The group’s research has focused on Medicaid eligibility checks, coordination among state agencies, managed care concerns and issues specifically in pharmacy and behavioral health efforts.
One of the most talked about recommendations among the task force’s members has been the push to strengthen eligibility determinations, including the use of tax data.
Legislative Auditor Daryl Purpera, who chairs the task force, said he hopes to see legislation in the upcoming session that will expand his authority to access some tax data currently unavailable to him in state law. “I don’t know how we do this as a state without access to the tax data,” he said.
Purpera said his goal isn’t to use his office to root out specific people, but to track trends in fraud and highlight any irregularities.
He cited a Minnesota study that looked at a sample group’s tax information and wage documentation to determine that 38 percent of the tested recipients were ineligible for the program level in which they were enrolled.
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The Louisiana Department of Health has been urged to study the potential costs for upgrading its information technology capabilities to use federal tax data for compliance.
The task force also wants LDH’s fraud unit, Medicaid fraud investigators in the Attorney General’s office and the Legislative Auditor’s office to hold quarterly meetings to discuss opportunities for coordination or sharing information.
“On several of the issues we are waiting on reports,” Purpera said.
The task force members said they also hope to see progress reports as they continue studying the program for efficiencies.
“I think as the program evolves, we’ve set ourselves some goals legislatively and administratively,” said Sen. Fred Mills, R-Parks.
Louisiana expanded its Medicaid program in July 2016 through the federal Affordable Care Act, prompting more scrutiny particularly among Republican legislators who have noted the program’s ballooning costs and enrollment.
Since the expansion took effect, nearly 465,000 people, mostly the working poor, have been added to the state’s Medicaid rolls.
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Under the expansion, Medicaid is now available to households that have incomes below 138 percent of the federal poverty level. That’s about $33,950 for a family of four or $16,640 for a single adult.
State health officials have defended the program’s growth, as it has pumped federal funds to pay for the additional coverage.
After gaining coverage through the expansion, nearly 300 cases of breast cancer have been diagnosed, 5,700 cases of diabetes and 14,530 cases of hypertension. Nearly 9,000 patients have received inpatient mental health services at a psychiatric facility after receiving coverage through the expansion and 43,000 through outpatient services. Nearly 7,500 adults have received outpatient care for substance abuse, and 8,340 have received residential substance abuse treatment.
Jen Steele, the state Medicaid director who is also a member of the task force, noted that some of the panel’s recommended changes can’t be made because of federal regulations, medical guidelines and industry standards.
She said LDH is in the process of enhancing its eligibility verification, but cautioned that some of the proposals from the task force could cost the program additional resources.