Health Care Reform News Around the Nation for the Week of Dec. 1

Idaho

The Idaho Department of Health and Welfare's Medicaid eligibility system contains thousands of errors because of the lack of coordination between the automated computer system used to determine Medicaid eligibility and the computer system used to process payments, according to a state audit released last month, the AP/Spokane Spokesman-Review reports.

The state Legislative Services Office first recommended the department reconcile the two systems in 2003.

According to the audit, "The last completed reconciliation was for a 13-month period and contained 23,240 errors."

More than 1,500 errors were corrected within five weeks, but more than 21,600 remained.

According to the auditors, because the systems have not been reconciled, some individuals' access to Medicaid is being delayed or is not being established. If the department does not completely develop and integrate the systems, the state's Medicaid program could face federal sanctions, auditors said.

Both computer systems are scheduled to be replaced next year and the department is working on a reconciliation process for the new programs, according to Emily Simnit, a spokesperson for the department (Boone, AP/Spokane Spokesman-Review, 11/21).

Nevada

Nevada physicians say a plan to reduce Medicaid hospital payments for inpatient services by 14% will lead more hospitals to eliminate services for beneficiaries, the AP/Las Vegas Sun reports.

The cuts would be on top of 5% "across the board" inpatient care reductions that resulted in larger cuts for certain services because the 5% is an average.  The state Department of Health and Human Services announced the across the board cuts earlier this year.

Those cuts have led some specialists to stop seeing Medicaid beneficiaries altogether.

The proposed additional cuts would cause some rural hospital closures, delays in care, emergency department overcrowding and fewer services at for-profit hospitals, according to Nevada Hospital Association Executive Director Bill Welch.

Hospitals in Nevada with more than 100 beds provided a combined $533 million in uncompensated care last year, Welch said. In addition, Welch said only 34% of state residents are able to pay for health care services provided.

Hospitals also have been warned that unless the state fixes its cash flow problems, Medicaid payments could stop completely by mid-March 2009 or early April 2009 until the next fiscal year begins in August 2009.

DHHS' Health Financing and Policy Division Administrator Chuck Duarte said the agency is expected to cut reimbursements for inpatient services by 10% in FY 2010, but these cuts could be precluded by changes to the state budget. The state already has the lowest rate of per capita Medicaid spending in the country (AP/Las Vegas Sun, 11/22).

Tennessee

TennCare officials have asked that courts grant them a suspension of a 20-year-old lawsuit that prevents the state from annually re-evaluating about 180,000 beneficiaries who may no longer be eligible for coverage, the AP/Tennessean reports. TennCare is the state's expanded Medicaid program.

Gov. Phil Bredesen (D) has requested that all state agencies reduce spending by as much as 15% to address a potential $800 million shortfall for fiscal year 2009.

TennCare officials are looking to cut nearly $1 billion from the program, $400 million of which is state funding.

If about half of the beneficiaries protected by the suit are found to be ineligible, as much as $200 million could be saved and the state could preserve benefits for those who do qualify for the program, according to TennCare Director Darin Gordon.

Bredesen said, "I'm hoping to manage it so that the only people who lose any coverage are the ones who are not entitled to it."

However, Tennessee Justice Center Director Gordon Bonnyman said the lawsuit "simply requires the state to be fair and accurate in deciding whether to cut off TennCare to disabled and elderly people." He added, "For more than 20 years, the state has yet to develop a process to fairly review these individuals" (Johnson, AP/Tennessean, 11/25).