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Lack of will, not money, explains LDH failures

Go to the dictionary and look up “audacity,” and there you’ll find the Louisiana Department of Health under Gov. John Bel Edwards.

That’s the conclusion drawn from the department’s latest attempts at damage control after scathing audits of its Medicaid provision. One identified very likely at least $62 million in improper payments on behalf of the Medicaid expansion population through the first part of 2018. In fact, because the figure looked at just a fraction of all enrollees, about five percent, the figure could be much higher.

The audit illuminated that LDH’s headlong attempt to qualify and stuff as many people as possible into the program unnecessarily led to that waste. In particular, under Edwards it reversed a decision that the state verify eligibility from an “determination state” to an “assessment state,” which the state only had implemented at the end of the former Gov. Bobby Jindal Administration because of the high error rate.

The more exacting Jindal requirement entailed using wage data. But Edwards dispensed with that, with his administration alleging that the error-ridden data suddenly had improved significantly over the previous few months and that it would be too burdensome on existing resources; in short, it needed more money to hire more people to do the additional vetting.

In addition, once enrolled, LDH only occasionally checked on that recipient’s wage data. Again, the department claimed it didn’t have the personnel to do this more often as did many states, especially with an antiquated computer system, recently replaced, that collated the data.

Please. It’s asinine to suggest that, with a $14 billion annual budget with around $4 billion in state money, LDH couldn’t divert a tiny sliver of that – even one-hundredth of the state portion could hire ten people – for that task.

The agency also crowed that the new system, implemented in the past couple of weeks, would cut down on the errors – and again claimed budgetary woes played a part by delaying system implementation, although that occurring under the Jindal Administration.

While it’s characteristic for Edwards and his mandarins to take a page from the former Pres. Barack Obama playbook and blame consequences they have created on his predecessor, in this instance the Jindal Administration had started the modernization effort in 2014, giving Medicaid eligibility verification priority. The Edwards Administration only awarded the contract last year. And that has nothing to do in any event with the politicized decision to change from determination to assessment.

Then there’s the other audit that faults LDH for activities involving improper payment detection and resolution. It discovered about two-thirds of cases had incomplete information, LDH largely ignored investigation of areas with the largest dollar amount potentially at risk, decreased reviews for improper payments while LDH eschewed methods that could have stemmed that, and it cavalierly settled cases that could have recouped the state more money otherwise.

LDH admitted these shortcomings, but blamed some of it on … wait for it … budgetary constraints. Again, this is a laughable assertion; the money was there – and more of it than ever as Edwards has overseen an increase in the range of $4.5 billion or almost 50 percent more spent a year on health care since taking office – but the will to spend it in a way that might limit improper Medicaid provision wasn’t.

The will wasn’t there because of the political imperative to pass out more of the goodie of Medicaid, particularly the new trinket of expansion, to win political support. The more people getting stuff (and misled to think it was “free”), the more potential votes Edwards could harvest for reelection purposes. If you had to crack a few taxpayer eggs to get there, so be it.

With health care swallowing almost half of the state’s entire budget, Edwards recognizes it as the major tool to buy votes. LDH’s attempt to explain away its lackadaisical enforcement efforts by poormouthing rings patently false, and its trying to deflect attention from its strategy of benign neglect exemplifies chutzpah.

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