The audit would be a first for SoonerCare, Oklahoma’s Medicaid program, and the state’s Medicaid Children’s Health Insurance Program. The Oklahoma Healthcare Authority (OHCA) would fund the audit, which would be conducted by an independent, private firm. The audit would cover the years 2015 through 2018 and would focus on eligibility determination.
“States across the nation have already completed Medicaid audits and found significant savings because of it,” Stitt said.
The audit request comes as there is increasing interest in granting the governor more control over who runs OHCA, which manages the state’s Medicaid program.
Currently, an appointed governing board hand-picked by 4 members of the legislature and 5 by the governor, selects OHCA’s leader. One proposal would make the agency more accountable to elected leaders by requiring that the board’s leader be chosen by the governor and confirmed by the Oklahoma Senate.
“The governor (has) had no authority to hire or fire the head of that agency,” Oklahoma Insurance Commissioner Glen Mulready told Health Care News. “It has always been the frustration for many in the legislature because we have $1 billion out of $7 billion in appropriations going to an agency that the governor had no control over.”
Out-of-Control Cost Growth
Over the past 20 years, Oklahoma’s Medicaid rolls have more than doubled, from 450,000 to nearly 1.1 million recipients. Mulready says plenty of bills have been filed to expand Medicaid, none made it out of committee and he didn’t think that would change before the state’s legislative session ends in May.
Mulready says there has been pushback against the proposed audit.
“The nature of the beast in state government is a push for the status quo,” Mulready said. “Most agencies don’t like being put under a microscope. I don’t think anyone is saying that anyone is not doing a great job, but we need to make sure taxpayer dollars aren’t being wasted by covering people who don’t meet eligibility.”
Jonathan Small, president of the Oklahoma Council of Public Affairs, says the audit will be beneficial for the needy.
“Medicaid was designed for the aged, blind, disabled, and truly needy,” said Small. “When we expand Medicaid, either through Obamacare or allowing people to stay on the program who are ineligible, it endangers the program by making it too costly for those who rightly need it.”
Audits Save States Millions
Audits of Medicaid rolls have been successful in several states. Audits found eligibility lapses costing taxpayers millions of dollars in Arkansas, Illinois, Minnesota, Nebraska, New York, and Ohio, according toa 2015 Foundation for Government Accountability Report, Stop the Scam: How to Prevent Welfare Fraud in Your State.
Small says as health insurance becomes more expensive, the “free” nature of Medicaid can attract people who don’t need it.
“People tend to abuse things that are free,” said Small. “What we don’t want is for people to drop their private coverage because copays are nearly nonexistent in Medicaid.”
Excessive Managed-Care Costs
It is important for states to remove from Medicaid rolls people who do not use the program, says Naomi Lopez Bauman, director of health care policy at the Goldwater Institute.
“We have a very fluid Medicaid population,” said Bauman. “People might move to another state or get a job where they get insurance. In this day when so many states have moved their programs to managed care, states are paying by person, so audits can really make an impact in saving money.”
The U.S. Office of Inspector General examined a sample of people in California from October 2014 to March 2015 and found Medicaid paid $738.2 million on behalf of 366,078 ineligible beneficiaries.
The FGA report states the U.S. Department of Health and Human Services determined 10 percent of all Medicaid payments are improper. In 2016, total Medicaid spending was $576 billion, according to the Centers for Medicare and Medicaid Services, up from $456 billion in 2013.
AnneMarie Schieber([email protected])is managing editor of Health Care News.