A joint legislative subcommittee will begin meetings next week with medical professionals, and officials who deal with Medicaid fraud, to discuss how the agency will move forward without what Medicaid said would be its bare minimum for funding.
Alabama House Rep. Steve Clouse, R-Ozark, said Monday during the Dothan Area Chamber of Commerce’s legislative update meeting that he and state Sen. Trip Pittman, R-Montrose, will chair a 10-member committee divided evenly between House and Senate members before which medical officials will testify on how the agency would move forward.
The Legislature has approved a $1.8 billion General Fund budget that upped Medicaid funding $15 million from last year to $700 million, but was $85 million short of what the agency stated was necessary to provide managed care through regional care organizations and to avoid cuts from some optional programs. AL.com reported some of the optional programs might include a home health program, hospice, outpatient dialysis, adult eyeglasses and PACE, a program to help some elderly people avoid having to be admitted to nursing homes.
Clouse said the subcommittee will likely speak with officials such as workers within hospitals, nursing homes, pharmacies and even fraud officials to discuss the current state of Medicaid and what the agency would look like going forward with cuts, particularly with the RCO program.
Clouse said there may be a possibility that Medicaid could receive more funding than what’s been approved if money can be found. He said the additional $15 million allotted to Medicaid from the House was through monies collected from a voluntary sales tax from online companies and transfers from other agencies.
Clouse said more than $300 million has been added to the Medicaid budget over the last decade, while agencies such as the state mental health and human resource departments, and the state court system, have each experienced between a $17 million and $31 million decline in the same time period.
“It doesn’t take rocket science to figure out that Medicaid is elbowing everybody else out of the way to the point that these other agencies just can’t function like they had been, so we’ve sort of drawn a line in the sand,” Clouse said.
“Even if you may not be on Medicaid, it’s important to the providers, …and it’s not something we’re taking lightly. We’re going to continue this debate and see where it goes. I’m not sure exactly where (more money) will come from, but…we’re going to talk about the situation and what their suggestions are about how we’re going to solve this problem.”
According to its records, Medicaid in Alabama was started by legislative action in 1970 as a state-assisted medical plan. By December 1970, the program identified 313,074 eligible residents for Medicaid by using data from the Department of Pensions and Security.
As of Fiscal Year 2014, about 1.2 million children and adults were considered eligible for Medicaid in Alabama.
Clouse said a part of the subcommittee’s tasks would be to hear more about fraud that takes place within the Medicaid system.
“There’s a fraud unit within Medicaid and results haven’t been too good in the last few years. We’re going to take a deep dive into that issue and ask some more serious questions in that regard,” he said.
Alabama Attorney General Luther Strange said last month during a visit in Dothan that a shortfall to Medicaid’s fraud division is its reliance on people to report the fraud without any type of incentive or reward.
He said Medicaid fraud, in large numbers, is by providers claiming services that have not been provided, rather than residents who falsely claim they are eligible for service. But Strange said there aren’t as many checks in Medicaid registration as for other areas of service.
“We don’t even know how much money is lost due to fraud in Medicaid,” he said.
“I think if we’re asking our citizens to pay hundreds of millions of dollars to this program, rooting out fraud is important because the people that are really hurt by that are not only the taxpayers but the people who want and need the benefits of Medicaid.”
State Rep. Paul Lee, R-Dothan, said he believed a part of the Medicaid issue might be that the system does more “handing out” than “handing up.
“We have children in need and elderly in need. …We need to start encouraging those that are able and willing to go to work rather than sitting and waiting for a check to come in,” he said.
“We can fix Medicaid in 24 hours if we could make our own rules (versus federal regulations) and do it the way it should be done.”