DHS: Technology-enabled initiatives, better data cut state Medicaid rolls by 80,000 in 2017

by Wesley Brown ([email protected]) 581 views 

As part of the state’s continuing efforts to cut rising Medicaid costs, the Arkansas Department of Human Services (DHS) announced Tuesday (Dec. 19) it had removed more than 80,000 individuals from the program through ongoing technology initiatives and access to data that improves the department’s enrollee count.

DHS Director Cindy Gillespie told reporters gathered at the agency’s downtown Little Rock offices that a year ago her department had just completed its exhaustive task of paring the backlog of more than 140,000 overdue Medicaid eligibility cases. In January, Gillespie apprised Hutchinson ahead of the 2017 legislative session that individual cases dating back to 2014 had been trimmed to less than 700.

Since then, Gillespie said the department has put into place processes to ensure its Medicaid rolls are accurate through several initiatives, including a partnership with the state workforce officials to identify new hires that receive health benefits, closing cases after receiving returned mail, and expanding a program that finds Arkansas enrollees receiving coverage in more than one state.

“We thought we needed to kind of take a minute to try and pull together a number of things we’ve worked on this year around accuracy and Medicaid rolls in particular, and where we are going next year in some of these areas,” Gillespie said. “As you will remember this time last year, we were finishing up the effort to get rid of our Medicaid backlog, and the county operations folks they’ve all been smiling because they won’t be working up to Christmas on the backlog.”

Hutchinson said in a statement that the work DHS has done is a model for containing costs and eliminating waste in state government.

“Director Gillespie and her team combined common-sense fact finding with new technology to reduce our load by 80,000 cases,” he said. “DHS is among state agencies that are leading by example, and I applaud the smart approach.”

In additional to the department’s ongoing initiatives to reduce the state Medicaid’s rolls, DHS also issued a request for bid for a new Electronic Visit Verification system, which will give the department the ability to make sure home healthcare aides who provide home and personal services to Medicaid patients are doing so.

John Parke, director of DHS Office of Payment Integrity, said the RFP is for a data analytics firm to develop a location-based app for mobile phones that will allow home healthcare aides to check in when arrive to the place they will provide services to Medicaid beneficiaries. Park said the app’s data can then be compared against claims information from healthcare providers.

“It feels good to know you are saving taxpayers’ money,” Parke said, adding that the RFP will be for $10 million over six years.

Led by Gov. Hutchinson, DHS has taken a number of other steps to create efficiencies and cost savings as state Medicaid expenses continue to grow, largely due to the expansion of the Arkansas Works program. In November, the number of people enrolled in Arkansas Works was down from a month ago to 306,849, compared to 309,719 in October.

Total expenses for Arkansas recipients enrolled in the state’s expanded Medicaid program under the provisions of the Affordable Acre Act, commonly referred to as Obamacare, tallied $133 million in November, or $519.89 per enrollee, compared to $134.5 million, or $518.63 per enrollee, in the previous month.

Altogether, the number of enrollees with premiums paid totaled 256,013, 2,870 less than October’s tally of 309,719. Premiums payments fell slightly to $95.91 million in November, or $374.63 per enrollee, from $96.78 million, or $373.20 per enrollee in October. Cost sharing costs also were down to $36.08 million, or $140.95 per enrollee, compared to $36.67 million, or $141.42 per enrollee, a month ago. Wrap services rose to $1.10 million, or $4.31 per enrollee, versus $1.04 million, or $4.01 per enrollee, in October.

Mary Franklin, director of DHS’s Division of County Operations, said much of the more than $80,000 in cost savings in the first 11 months of the calendar year have come from a wide-range of programs. For example, Franklin said a partnership with the state Department of Workforce Services to capture previously unreported new hires has resulted in 16,467 cases being closed out.

Another 25,742 Medicaid cases have been shuttered because of multi-state program to identity individuals receiving benefits from more than other state. And about 26,100 beneficiaries have lost benefits after DHS officials streamline a process to sort large volumes of returned mail due to “bad addresses, Franklin said. Arkansas Medicaid recipients are required to report a change of address to DHS to ensure they remain in state.

The director of DHS county operations said another 5,000 or so cases were closed by removing incarcerated individuals from Medicaid rolls and by working with healthcare providers to identify workers with wages over the federal poverty level getting coverage through Arkansas Works and the federal marketplace.

“Thanks to newly-available technology and sister state agencies, we made a great deal of progress (in 2017) in improving the integrity of the Medicaid rolls,” Franklin said. “We will continue these processes in 2018 so that we know only individuals who are truly eligible are getting coverage through Medicaid.”

Last week, Gov. Hutchinson thanked the state Tobacco Settlement Commission (ATSC) for its support in paring down more than 500 families on the waiting list for a Medicaid waiver program that provides services offering home and community-based care for developmentally disabled children.

But Hutchinson also warned there are still challenges to stemming Arkansas’ rising Medicaid costs, noting that he is still awaiting approval for a long-sought after federal waivers from the Trump administration to cap income eligibility for the state’s Arkansas Works program at 100% of the federal poverty line.