Liam, thanks for a good take on an important issue. Couple points of debate I would offer:
1) as a former contracted internal auditor of CMS, I challenge anyone to quantify if an 8.6% rate of FWA is a "serious integrity" issue. My audit team challenged Deloitte on the same take. Given that the Blues typically report "administrative costs" of their plans at 15%, it demands very specific discussion, not the usual hand-wave.
2) as a resident of Mississippi, I'm here to offer you can change any level of Medicaid programming and CT will always get more than MS. There's a fairly direct correlation of state revenue to political attitude towards Medicaid. How can a state like MS that remains 1 of 10 holdouts in expanding their Medicaid program (which CT did immediately in 2013) ever expect to be allocated the same dollars or more?
1) I appreciate your perspective on this. I confess that I'm not an expert on how Medicaid's improper payment rate is calculated, which is why I made clear that I wasn't arguing that the 8.6% figure necessarily represents waste, fraud, or abuse. Still, I think that prosecutors and auditors have exposed enough confirmed cases of Medicaid fraud to raise serious concerns. Just the other week, a hospital system in Delaware agreed to pay $47 million to settle a Medicaid fraud lawsuit.
2) I completely agree that political attitudes toward Medicaid play a big role in determining how much a state spends on the program. But, surely, fiscal constraints impact program funding too. Holding political attitudes constant, a state will spend different amounts if faced with a 50% FMAP vs. an 80% FMAP. Essentially, my view is this: If the residents of MS don't want to spend much on their Medicaid program, fine -- but at least have them make that decision on an equal fiscal footing as other states.
You're right that the comparison between CT and MS is complicated by the fact that one state has expanded Medicaid and the other hasn't. But, as I note in the piece, the trends I document largely hold across the country when I drop non-expansion states from the analysis. So this isn't just an artifact of some states holding out against expansion. Also note that one of my recommendations is to mitigate the disparity between expansion and non-expansion states by gradually reducing the expansion group FMAP to the regular FMAP.
1) You make a great point, and I'll add I've been involved and/or aware of numerous solutions that would find and preclude fraud before it began, instead of after-the-fact, and what is usually some reparation that only partly covers what was lost.
Regarding 2) I totally love "at least have them make that decision on an equal fiscal footing as other states.". At least it further exposes states like MS that repeatedly deny money to be transparent about it.
Liam, thanks for a good take on an important issue. Couple points of debate I would offer:
1) as a former contracted internal auditor of CMS, I challenge anyone to quantify if an 8.6% rate of FWA is a "serious integrity" issue. My audit team challenged Deloitte on the same take. Given that the Blues typically report "administrative costs" of their plans at 15%, it demands very specific discussion, not the usual hand-wave.
2) as a resident of Mississippi, I'm here to offer you can change any level of Medicaid programming and CT will always get more than MS. There's a fairly direct correlation of state revenue to political attitude towards Medicaid. How can a state like MS that remains 1 of 10 holdouts in expanding their Medicaid program (which CT did immediately in 2013) ever expect to be allocated the same dollars or more?
Thanks for great topics to discuss!
Thanks, Jim! Great comments.
1) I appreciate your perspective on this. I confess that I'm not an expert on how Medicaid's improper payment rate is calculated, which is why I made clear that I wasn't arguing that the 8.6% figure necessarily represents waste, fraud, or abuse. Still, I think that prosecutors and auditors have exposed enough confirmed cases of Medicaid fraud to raise serious concerns. Just the other week, a hospital system in Delaware agreed to pay $47 million to settle a Medicaid fraud lawsuit.
2) I completely agree that political attitudes toward Medicaid play a big role in determining how much a state spends on the program. But, surely, fiscal constraints impact program funding too. Holding political attitudes constant, a state will spend different amounts if faced with a 50% FMAP vs. an 80% FMAP. Essentially, my view is this: If the residents of MS don't want to spend much on their Medicaid program, fine -- but at least have them make that decision on an equal fiscal footing as other states.
You're right that the comparison between CT and MS is complicated by the fact that one state has expanded Medicaid and the other hasn't. But, as I note in the piece, the trends I document largely hold across the country when I drop non-expansion states from the analysis. So this isn't just an artifact of some states holding out against expansion. Also note that one of my recommendations is to mitigate the disparity between expansion and non-expansion states by gradually reducing the expansion group FMAP to the regular FMAP.
Thanks Liam! Excellent feedback.
1) You make a great point, and I'll add I've been involved and/or aware of numerous solutions that would find and preclude fraud before it began, instead of after-the-fact, and what is usually some reparation that only partly covers what was lost.
Regarding 2) I totally love "at least have them make that decision on an equal fiscal footing as other states.". At least it further exposes states like MS that repeatedly deny money to be transparent about it.