TU: NY Medicaid Beneficiaries Shouldn't Pay for State/Federal Mistakes of the Past

NYAPRS Note: The Albany Times Union aptly points out that the recent deserved scrutiny over NYS Medicaid practices should not ignore the tremendous progress underway via the state’s Medicaid Redesign initiatives and should not hold hostage New York’s $10 billion Medicaid Waiver proposal that’s designed to further accelerate these crucial reforms.

Investigation, or Political Hit Job?

Albany Times Union Editorial February 10, 2013

Our opinion: There’s nothing wrong with an honest look at New York’s massive Medicaid program, but given Republicans’ animosity toward social programs, a House committee’s interest is suspect.

Point to a government program, declare “Waste! Fraud! Abuse!” and vow to clean it up, and you’re sure to get applause from budget hawks. And with a program as big as New York’s $54 billion Medicaid operation, you’re pretty much guaranteed to find something if you poke around.

What the federal government says it found is not small change - at least $15 billion in improper payments to the state over 20 years. But as with everything in politics - and, yes, this is as much politics as it is dollars and cents - there’s more to the numbers than meets the eye.

The money represents what the federal Center for Medicare and Medicaid Services says New York improperly - possibly illegally - billed it for reimbursements for disabled people who had been released from state developmental centers.

CMS says the federal government was paying twice - once to New York for former clients, and again to other care providers who actually served them after they were released from state care.

Ah, but there’s a hitch: CMS knew of the arrangement and approved the payments.

Now CMS wants the money back. And the House Committee on Oversight and Government Reform says it’s one more piece of evidence that New York’s Medicaid program is the most wasteful in the nation.

To be sure, Medicaid in this state bears closer examination. Federal Medicaid funds are for health care for the poor, not for fattening state coffers.

But there’s abuse, and then there’s abuse. Misinterpretation of the rules is by no means the same as, say, doctors billing for fictitious patients.

That isn’t stopping House Republicans, though, who have had this country’s great social programs - Medicaid, Medicare and Social Security - in their sights for years. What better example than one of the bluest states? Especially when New York is in line for a $10 billion bonus for reforms it has made to Medicaid.

New York’s program is so big mainly because governors - Democrats and Republicans alike, over decades - have taken maximum advantage of a 50-50 federal-state split on Medicaid to provide health care to the poor. Billing half the cost to the federal government is one way New York can at least begin to make up for the fact that its citizens send far more money to Washington than the state gets back- money that tends, incidentally, to go mostly to red states.

Nor does the House committee seem to want to acknowledge the steps New York has taken in recent years to rein in real fraud and abuse and recover hundreds of millions of dollars. Instead, it’s focused on claims that the Cuomo administration has lately softened Medicaid fraud probes in response to pressure from the health care industry.

Don’t get us wrong. If Congress can find real waste, fraud and abuse in New York’s Medicaid program, or laxity in program administration, more power to it.

But there is a difference between a fair, earnest investigation and a witch hunt. Moreover, it would be unfair to hold the state liable for mistakes the federal government was entirely complicit in. It would be counterproductive to withhold money that was promised in exchange for reforms.

And it would be unconscionable to use this as an excuse to hurt Medicaid and the millions of poor people whose lives literally depend on it.

http://blog.timesunion.com/opinion/investigation-or-political-hit-job/24036/