Idaho Medicaid payment delays hurt families, employees: Patients are denied service, and workers are without or with less pay [The Idaho Statesman, Boise]

Aug. 07--The past two months would have been a nightmare for Jean Young if not for her granddaughter, Danielle Markham. She stepped in to provide personal care for her grandmother at home.

Young, 83, a cancer survivor with severe arthritis and chronic obstructive pulmonary disease, needs a home health care worker to help her with bathing. She was getting one through Medicaid.

But that care stopped briefly when Young used up all the care for which she had qualified. She was then requalified by Medicaid for additional care, but the home-care provider wouldn't take her back. The provider said the company couldn't afford to, because Idaho has fallen behind on paying its bills.

Young is among thousands of Idahoans who have been affected by delays in Medicaid payments as the state and a contractor, Molina Healthcare Inc., grapple with Molina's troubled new claim-management system.

Molina is supposed to be processing and paying the state's bills from home-care providers, nursing homes, assisted-living homes, physician's practices, clinics, health districts, counseling centers and hospitals that treat Medicaid patients. Medicaid is the state-federal health insurance program for low-income and disabled people.

But the state's checks have been coming late or represent only a fraction of the amounts the provider businesses are owed.

As a result, about 1,400 employees of health care providers told the Idaho Department of Labor in July that their wages had been reduced, their pay days changed or their pay withheld because of the delays in Medicaid payments from the state, department spokesman Bob Fick told the Idaho Statesman.

Providers are "telling people they'll get money, but they don't know when," Fick said.

NO PENALTY AFTER ALL -- AT LEAST NOT NOW

Idaho Department of Health and Welfare spokesman Tom Shanahan sighed when he heard that statistic Friday. "We apologize for that," he said.

A Health and Welfare official said earlier this week that the state plans to penalize Molina over the problems. On Friday, however, the department backed away from that.

In a meeting with Health and Welfare Director Richard Armstrong, Molina executives vowed to bring in 40 additional employees -- including managers, claims adjusters and customer-support staff -- to fix the problems. Armstrong directed $55 million in "extra" payments to providers to fill in the gaps until the system is fixed, and a Health and Welfare spokesman said providers should receive those payments Monday or Tuesday.

"We have providers who have absolutely been pushed to the wall and cannot survive without payments -- providers who we count on to serve some of the state's most vulnerable citizens," Armstrong said in a news release.

Molina executives could not immediately be reached for comment.

But they acknowledged to Armstrong that they had been understaffed when they launched the program in June, a Health and Welfare news release said.

Shanahan noted that the troubled program was being developed by Unisys for two years before Molina acquired Unisys in May -- a little more than one month before the system took effect.

"So we shouldn't be too hard on them right now," Shanahan said. "Penalties may be considered in the future, but not right now. We need to give them a chance to perform."

STATE TO BUSINESSES: PAY YOUR WORKERS

Meanwhile, businesses that delay paying workers may face state enforcement action such as financial penalties and liens. The law demands that employees be paid in a timely way, said Fick, the Labor Department spokesman.

"We don't care what reason they've got for not paying," Fick said.

Providers say they're in a jam, as the state on one hand requires them to pay salaries, workers compensation and other business costs, while on the other the state pays the providers only when and how it wants.

On top of all that, a recent letter from the department to providers says the state will begin withholding 25 percent of weekly claim payments to providers who have received interim checks that were issued to keep at least some cash flowing while claims were processed. The 25 percent reduction will begin Sept. 6 until the interim payments have been repaid to the state, the letter says.

"They set all these deadlines we have to meet, but they're not meeting deadlines," said Rick Heikkila of RH Mental Health Services in Nampa, which handles case management, counseling and rehabilitation for adults and children. "It's like a crap shoot. It makes it very difficult for us providers to plan anything."

Emily Simnitt, another Health and Welfare spokesperson, said Molina won't begin reconciling claims with interim checks until after the system is performing as it should. Simnitt didn't know how that would affect the Sept. 6 deadline. Officials hope the reconciliation will begin in the next few weeks, she said.

SERVICES TO CHILDREN SAVED

Teresa Alexander, chief executive officer of the Children's Home Society of Idaho, said a $100,000 check that arrived Thursday in the mail at her 102-year-old nonprofit came just in time. After nine weeks with only one payment amounting to about a quarter of what it was owed, the organization was on the verge of having to eliminate services such as counseling to about 200 children. The state still owes the society more than $200,000.

"It was a very close call," she said.

Young, meanwhile, has a new provider, thanks to a frantic search by her granddaughter. On Thursday, the two were sitting together in Young's Star home, with Young dressed in bright colors and fresh from a bath with Markham's help.

She said she's grateful to be in Idaho near family, but she's found assistance programs in other states like Colorado easier to navigate.

"They should do something better for seniors," Young said.

Sandra Forester: 377-6464

To see more of The Idaho Statesman, or to subscribe to the newspaper, go to http://www.idahostatesman.com

Copyright (c) 2010, The Idaho Statesman, Boise

Distributed by McClatchy-Tribune Information Services.

For more information about the content services offered by McClatchy-Tribune Information Services (MCT), visit www.mctinfoservices.com, e-mail [email protected], or call 866-280-5210 (outside the United States, call +1 312-222-4544)