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June 29--A lot is riding on the capacity of the state Department of Human Services to manage health coverage for Hawaii's lower-income patients. That's especially true with the Affordable Care Act still in its early stages and government expected to handle a heavier burden in ensuring medical care.
So the latest upheaval to beneficiaries of Medicaid in Hawaii signals the need for a rapid-response team to get to the bottom of problems at DHS, not for another round of the blame game that's now playing out.
Earlier this month, at least 4,582 families enrolled in Medicaid through the DHS Med-QUEST Division received letters that told them in error that they would be dropped at the end of June from the coverage program, known locally as Quest.
Last week, worried enrollees and families, some with medical appointments already on the calendar, flooded state Medicaid offices.
DHS Director Pat McManaman told the Star-Advertiser that the error was the fault of the agency's contracted mailing company, Cardinal Mailing Services Ltd., which did not return calls for comment.
McManaman said the vendor failed to send the earlier notice, a renewal form, on the scheduled May 9 date. DHS had sent Cardinal a file with the addresses of everyone due a renewal form to be mailed, she added, but Cardinal did not open and print the entire file. And then because the renewals were not received by DHS, the cancellations went out.
Even if this explanation covers the full extent of the problem -- and without a statement from Cardinal, that can't be assumed -- there have been too many snags in operations lately to let this slide. McManaman said that ultimately nobody has lost insurance, and apology letters going out now extend continuous coverage through Aug. 31.
But the disruption to families, who had to stop everything and rush down to state offices for reassurance, was far too great to wave off like that.
Lawmakers, who seem fully aware of the dysfunction, need to step in and call for a full accounting of the problems. An informational briefing should be slated where McManaman and other DHS officials could answer questions about the slate of problems over the past several months.
Some of them may be related to information technology. The recent rollout of the agency's $95 million online eligibility system, known as Kolea, has had documented problems. At this point, the state's Office of Information Management and Technology should take charge of implementing a fix or, more likely, several of them.
In May, the department mistakenly notified 4,500 aged, blind or disabled individuals that their benefits would end. Those notices were generated "as a result of adding new long-term care functionality" to Kolea. McManaman contends that the latest problem was not due to Kolea.
But there have been numerous reports by DHS employees, who asked not to be identified, who beg to differ, pointing to a string of software glitches.
Whether such reports qualify as a smoking gun or merely a red flag, they're not something to be ignored.
The enactment of the ACA has added new requirements for financial information from Medicaid bene- ficiaries, so the state has compelled enrollees to actively renew to collect that data.
But that data collection and other aspects of the Obamacare rollout has been plagued with so many problems that the public's confidence in DHS competence has been badly shaken. Last year, for example, the state sent 250,000 Quest members information about their health insurance options, but inadvertently left out information from Kaiser Permanente, one of the two biggest players in the market. Another day, another correction mailout: That one cost taxpayers $176,254.
The Medicaid network -- everyone from the enrollees themselves to the practitioners and staff at the health clinics delivering the care -- are rightly incensed about all the snafus.
But the whole state is underwriting the cost of these errors, so the general public has the prerogative to feel indignant, too.
Hawaii has a tradition of care for the poor and indigent, but let the investment in such social programs go to the services themselves, and not to the cleanup of huge mistakes that shouldn't happen in the first place. DHS needs to answer for its failure to perform its health-care role competently.
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