NMI Medicaid Cases “Circulate in Hawaii Like Hot Potatoes”

by Tammy Doty, Marianas Variety, April 26, 2012 (excerpt)

THE local Medicaid program is overwhelmed, underfunded and staring down the barrel of a crisis.

Private clinics and pharmacies have whispered among themselves for months about suspending services due to non-payment of millions.

The program has made an sincere effort in conjunction with the Department of Finance to release smaller checks to vendors in prior months, but the miniscule $400,000 a month available to divvy-up between both on-island and off-island vendors is abysmally inadequate.

The NMI’s medical referral office told a February Commonwealth Cancer Association meeting that off-island Medicaid providers were becoming scarce due non-payments, and cases were circulated in Hawaii like hot potatoes, as no healthcare provider wanted to be the last one holding the files.

NMI providers began quietly scaling back Medicaid caseloads in the past few months, with most dental providers suspending program clients’ care because payments are so far behind.

A visit to Capital Hill Medicaid speaks for itself, as literal stacks of reimbursement paperwork render some offices almost impassable, and provides all the evidence needed to realize that the program is on the verge of collapse.

Crushing numbers

Medicaid’s lone eligibility worker processed 17,237 applications in fiscal year 2011.

Of that massive number, 7,577 applications were approved for the program.

For the first six months of FY 2012 (October to present) the Medicaid office received 9,049 applications, and is on track to beat last year’s total number by eight to ten percent….

More clients than dollars

Total federal Medicaid funding available to the CNMI in FY 2012 is $32.8 million.

The problem in accessing the sizeable amount is that the NMI does not have the 45 percent local matching money equal to $14.5 million.

Because the government would not be able to pass the $32.8 million threshold, Medicaid recently approved NMI’s CHIP waiver request.

The approval granted permission to draw down an additional $634,921 in funding during 2012.

Adding to the positive news was that Medicaid does not require local matching funds for the CHIP program.

The NMI allocated only $2.4 million for the 45-percent local matching requirement in FY 12, which allows a total draw-down of approximately $5,350,000 in federal funds.

The amount dovetails with Gov. Benigno R. Fitial’s statement of capping Medicaid 2012 expenditures at $5.3 million.

In 2011, local Medicaid spending surpassed its budget allocation by $6.182 million.

Using the latest numbers available from 2010, it was easy to see why the NMI overspends on Medicaid.

Total billings to NMI Medicaid totaled $8.540 million.

NMI providers billed $7.191 million, while Hawaii/San Diego billed for $1.041 million and Guam at $308,576.

Should Medicaid stick to the $5.3 million FY 2012 budget, the program would reduce spending from prior years by an eye-popping 61 percent this year.

As the dollars dry up and payments are chronically small, many authorized providers have either stopped accepting clients or are in the process of winding-down Medicaid appointments.

“I don’t want to tell my patients I can no longer accept them, but like CHC, my practice is running very low on cash,” explained one dental provider, who wished to remain unnamed.

Currently, five dental, two eye clinics, two pharmacies and 17 practices are authorized to provide Medicaid health services in the NMI, for approximately 6,400 clients….

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