MEDI-CAL: Computer Glitch Proves Costly For Counties
"A state health contractor's computer glitch cost Contra Costa County at least $247,000 in Medi-Cal funds and perhaps as much as $2 million," a county official said yesterday. And "[d]epending on how long the mix-up lasted, it might have cost the Alameda County health plan from $400,000 into the millions," the Contra Costa Times reports. Meanwhile, the problem caused Riverside and San Bernardino counties to lose track of 12,000 Medi-Cal enrollees in the Inland Empire Health Plan. The glitch occurred last month when Maximus, "a Virginia-based contractor that enrolls Medi-Cal clients, had computer coding problems that put 120,000 people on hold statewide rather than steering them into county-level health plans" (see CHL 3/9).
When Did It Start?
According to state Department of Health Services spokesperson Ken August, no Medi-Cal recipients "went without care" due to the glitch. But the Times notes that the recipients "remained in individual Medi-Cal coverage accounts, costing county health plans millions of dollars intended for new managed care programs." August noted that Maximus "has fixed the problem and managed care enrollments started March 2." However, August said "the state is still investigating the miscue and can't answer such questions as whether Maximum faces a penalty, whether the state will reimburse county health plans, and when the problem started." He said the state "learned about the error in late January and the problem may have started shortly before." However, Richard Bruno, head of the Inland Empire Health Plan, "had a less optimistic estimate -- perhaps nine months to a year." Contra Costa County Health Plan Executive Director Milt Camhi said, "It's a pretty big issue with us. We lost nearly a quarter of a million dollars a month, and it could have gone back to last May."
An Important Issue
Camhi said the "glitch caused more problems for health plans already struggling with uncertain future." The Times notes that "the state has changed formulas for how the county-run plans will divide the Medi-Cal population with commercial providers." Because "counties based their health plans on state calculations of minimum enrollments they needed to survive financially," Camhi and Alameda County Alliance for Health's Nina Maruyama said "[c]ounties need some solid figures to plan and invest in their health care."
Contra Costa Challenge
At the same time, the Times reports that the "number of Medi-Cal clients has dropped, apparently because of welfare reforms and an improving economy." As a result, Contra Costa County "has seen its overall enrollment drop to 37,000" -- below the 39,000 minimum the state says it needs to remain solvent. The state is also "negotiating with Blue Cross ... to compete" against the county's plan. Camhi said, "You can't just turn a health plan on and off. We've opened a new health center. We need to plan for how many doctors and nurses to hire, how much equipment and supplies to buy. It's hard when the state keeps changing the numbers" (Spears, 3/25).