Medicaid payment system is broken

To the editor:

TEFRA Medicaid is a special program that is based on a child’s condition and not family income. TEFRA currently provides approximately 1,000 Alaskan children who have special needs and/or complex medical conditions with additional medical insurance. The program utilizes an independent care coordinator to assist parents in navigating the multiple agencies that determine financial disability and level of care eligibility.

In 2007, the state awarded a contract for a new Medicaid Management Information System (MMIS) to Xerox. The system was to be operational in summer 2010. On October 1, 2013 MMIS finally went live … 40 months late. The system has been fraught with problems since day one. The state has paid out over $135 million in advance payments to Alaska medical providers to help maintain their business solvency while the system is being “fixed.” This process has been a paperwork nightmare for all involved as providers do not know what claims were approved for the “advance payment;” they are just given a percentage of what the State believes they are owed based on suspended claims. Then when the state wants its money back it does not tell the provider if the money recouped is from advance payments or from approved claims. Your check is simply 10 to 30 percent less until you have paid back what you are said to owe.

I have not been paid in over a year for the services I have provided the state. I am loathe to request an advance payment and have managed to stay financially solvent the last 12 months by utilizing my savings and cutting costs. When the MMIS system was built the TEFRA program was overlooked: the system does not recognize the TEFRA number assigned to the child. (Thankfully, the physician, therapist or pharmacy does not have to include the TEFRA number to bill for their services, so the child is able to receive basic medical care.) However, as a care coordinator I am only allowed to bill under four codes: three of those codes do not work and the fourth code occasionally works.

The Enterprise MMIS has experienced implementation delays in New Hampshire (five years, three months before being fully operational) and North Dakota (four years, 11 months before being fully operational). Both of these states were having problems before Alaska awarded the contract to Xerox. Montana, California and Washington, D.C. have also experienced significant implementation delays. Nevada terminated Xerox for poor performance on their health care exchange and Texas has filed two lawsuits against Xerox for improperly paying out $1.1 billion in claims.

This type of record is not acceptable. Xerox needs to be financially penalized. Medical providers need to have all claims adjudicated within six months and individuals at the state level who have allowed this debacle to proceed need to be held fully accountable. Enough is enough.

E. Chadene Krome,

RN, BSN

AlasKIDS

Care Coordination