Auditor’s report depicts disarray in R.I. social service programs

April 10--PROVIDENCE, R.I. -- A newly released audit shows serious disarray in Rhode Island's programs for the poor and the elderly during most of last year, to the point where there were 16,000 more people getting state and federally subsidized Medicaid benefits than the state had listed as eligible.

Other findings: Duplicate payments for medical services. A failure to update the income-eligibility of thousands of cash-assistance recipients. A failure to provide "correct cost-sharing amounts" for parents with children in taxpayer-subsidized child-care, resulting in the need for the state to make "supplemental payments." Thousands of backlogged applications for food stamps and other benefits, including entry into nursing homes.

The report by the General Assembly's Auditor General Dennis Hoyle both retraces and uncovers new layers-of problems attributable to the Raimondo administration's ill-fated launch in September 2016 of the Deloitte-designed, eligibility-verification computer system known as UHIP in a project costing nearly $492 million.

The audit also spells out the continuing risk that the federal government will levy fines -- or seek to recoup -- some of the $2.1 billion in federal dollars the state spent during the year that ended on June 30, 2017, on food stamps, Medicaid, the Children's Health insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), and subsidized child-care.

The ramifications include the "potential disallowance of certain system development costs ... sanctions imposed by federal grantor agencies for noncompliance with specific program requirements ... and requests for return of federal funds for benefits provided to ineligible individuals," the report warned.

"It is important to keep in mind that this report reflects a finite time period, ending in June of last year," said Ashley O'Shea, spokeswoman for the Executive Office of Health and Human Services.

"We've made considerable progress since then in addressing many of the findings ... [and] the state continues to withhold payment from Deloitte until [the computer system] is fixed and meeting performance targets," she said.

State Medicaid Director Patrick Tigue also said there has been "significant progress." But he acknowledged that the progress is comparative: there were only 1,200 backlogged applications for Medicaid-covered entry into a nursing home or assisted living facility in March. A month earlier, the count number of applications that were 90 days old or older was 240 higher.

While some of the problems may no longer be as severe, the American Civil Liberties Union of Rhode Island -- which is suing the state for failing to quickly get food stamps into the hands of people who urgently need them -- on Monday called it frustrating that the processing of food stamp applications slowed in February.

The state's Human Services Director Courtney Hawkins vehemently disputed that, saying the ACLU only looked at what happened in a single month, when the March backlog was 30 percent less than it was at the same point a year ago. She said the backlog of cases awaiting state action has shrunk from "thousands" to 11.

She said her agency has already fixed -- or is "on a runway" -- to fixing other problems. (The next big computer "fix" is scheduled for May 19.)

Among the "significant" problems cited in the auditor general's report:

The state's Medicaid payment system reported 16,000 more recipients than listed in the flawed eligibility-verification system that began its life as "UHIP" (short for: Unified Health Infrastructure Project) and is now referred to by the Raimondo administration, as "RIBridges."

This compromised the state's ability to make sure "payments are only made on behalf of eligible individuals," the audit report said, and resulted in duplicate payments to one or more of the three managed-care organizations under contract to tend to 250,000 or so people in the state's Medicaid population: the Neighborhood Health Plan of Rhode Island, Tufts Health Plan and UnitedHealthcare Community Plan.

(Tigue said the discrepancy between the state's payment system and its income-verification system has dropped from 16,000 to 7,400. It was not clear how many of those people -- no longer in the count -- were ineligible for the benefits they received, but Tigue acknowledged there were some.)

Medicaid: "In many instances, particularly for Medicaid applicants requiring long-term care services and supports, the State is not complying with timely determination of Medicaid eligibility requirements ... [resulting] in significant delays in determining eligibility," the report said. This, in turn, necessitated the state "advancing"' money to the nursing homes and other long-term care service providers.

The state advanced $12.5 million to nursing home operators initially for delays early on in making Medicaid eligibility determinations for patients, which were federally reimbursed "but did not meet criteria for reimbursement," the report said. (The state's advances since July 1 to the nursing homes alone have totaled: a reported $47.5 million.)

Subsidized child-care: The computer system was not, on a consistent basis, calculating the correct "cost-sharing amounts" for parents with children in child-care. (DHS' Hawkins said her agency has taken several corrective steps, including stepped-up notifications to parents and the addition of a new feature that allows the operators to regularly report the names of children enrolled in their care.)

Temporary Assistance for Needy Families: The failure to regularly update recipient "work plans" meant the state was not complying with "income eligibility and verification" for this cash-assistance program.

On Thursday, the House Committee on Oversight is scheduled to hear a presentation by Deloitte Consulting, which has reportedly credited the state for $85 million of work since it last got paid.

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