Federal audit finds Pennsylvania Medicaid error rate less than half of national rate

December 22, 2010

On November 15, the U.S. Department of Health and Human Services released findings from its audit [pdf] of the Pennsylvania Medical Assistance program.  The audit found that Pennsylvania’s Medical Assistance, or Medicaid, error rate was 4.07%, less than half of the overall national Medicaid error rate of 8.98%.

Ever better news can be found in the details of the report.  Nationally, the error rate for eligibility determinations (i.e., whether the recipient is actually eligible for Medicaid) is 7.60%.  But Pennsylvania’s eligibility determination error rate is a low 1.97%.  That means that less than 2% of Medical Assistance recipients may not have been eligible for the assistance they received.  (The other errors were found in the fee-for-service or managed care programs that had insufficient documentation or provided incorrect diagnosis codes.)

Pennsylvania’s lowest-income families, children, the elderly, and disabled rely on Medical Assistance.  The Department of Public Welfare is to be applauded for administering this critical program so efficiently.

This federal audit contrasts with Auditor General Jack Wagner’s report last year that the Department of Public Welfare had a much higher error rate in the Medical Assistance program.  Why the difference?

Auditor General Wagner’s audit confused administrative errors with intentional fraud.  The Auditor General asserted that the Department of Public Welfare made errors in eligibility determinations for Medical Assistance applicants that countenanced fraud.  In truth, many of the errors had no bearing on applicants’ eligibility: they were eligible for the program but simply didn’t provide (or the Department of Public Welfare couldn’t produce) the requested paperwork.

The Department of Public Welfare should continue to modernize its operations to further reduce its low error rates.  But to do so may require additional budget and staffing. The number of caseworkers in County Assistance Offices, for example, has been reduced dramatically as a result of budget cuts.  There are currently more than 1,600 fewer staff at County Assistance Offices than there were in January 2003 – a 20% reduction.  Meanwhile, the number of households that rely on Medical Assistance has ballooned from 1.8 million individuals in 2006 to more than 2.2 million individuals today – an increase of over 22%.

The Auditor General’s recommendations (for example, that caseworkers verify income twice as frequently) would create an overwhelming administrative burden for caseworkers at a time when they are given insufficient resources to handle staggering caseloads.


CLS advocates offer suggestions for improvement to Governor-Elect Corbett’s transition team

December 9, 2010

In recent years, Pennsylvania’s Department of Public Welfare (DPW) has confronted unprecedented challenges.  Like most state agencies, DPW has faced repeated operations budget cuts, resulting in a severe staff shortage.  At the same time, DPW has seen extraordinary demand for its programs from Pennsylvania families that have been hit hard by the recession, especially Medicaid (Medical Assistance) and Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamp) benefits.  These dual pressures on DPW almost certainly will not abate in the coming years.  However, the pressures create opportunities to look with fresh eyes at technological and operational efficiencies that can make DPW a more streamlined, responsive agency.

This week, CLS advocates in the public benefits unit forwarded four briefing papers to Governor-elect Corbett’s transition team offering suggestions on how DPW could respond to the challenges ahead.

You can read them here.

Will 43,000 Pennsylvanian workers lose their health insurance in February?

December 6, 2010

AdultBasic, a subsidized health insurance program in Pennsylvania that provides coverage to over 43,000 low-income Pennsylvanian workers, may run out of money as early as February 2011 unless the Commonwealth’s four Blue Cross/Blue Shield Plans act soon.

The Pennsylvania Health Access Network has more information at their website.

PHAN has called a rally for tomorrow, Tuesday, December 7th at noon outside Independence Blue Cross, 19th & Market.  For more information or to RSVP, email Athena at aford@pahealthaccess.org.

Be sure to get your FULL property tax or rent rebate!

December 3, 2010

It’s once again time for some low-income Pennsylvanians to file for the Property Tax/ Rent Rebate.    Unfortunately, some unscrupulous companies are looking for a piece of this much needed support.

The Pennsylvania Property Tax/Rent Rebate is an annual tax rebate designed to give up to $650 back to low-income seniors, widows and widowers over 50, and some disabled residents. The form is simple, and can be found on the Department of Revenue’s website.

This year, applicants can have income of up to $35,000 per year, and half of all Social Security income is excluded.

Last month, the Pennsylvania Attorney General’s office warned Pennsylvanians that at least one company, the Senior Advisory Center (SAC), has sent misleading mailings to seniors, including several CLS clients,  offering to file the rebate forms for $39 – almost 7% of the average filer’s benefit.

Most seniors would not need help with this simple form, and a variety of free help is readily available from local community organizations and legislator’s offices, where paper copies of the form are available. You can also get help with the forms directly from the Department of Revenue by calling 1-888-222-9190.

The deadline to file for this year’s Rebate is December 31, 2010.  You can download the form at http://www.revenue.state.pa.us. You can get help with filing or completing the application calling the department at 1-888-222-9190. If you have had interactions with SAC or companies like them and feel as though their practices were deceptive, call the Attorney General’s complaint hotline at 1-800-441-2555.