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NC is #1 in USA!! (For Highest Percentage Increase in Total Medicaid Spending)…and What About the Rest of the USA?
On October 21, 2013, the magazine Modern Healthcare published an article, “Medicaid budgets By State,” which showed each state’s total Medicaid spent in 2012, total number of Medicaid enrollees in 2012, and average spending per enrollee in 2012.
Where does North Carolina rank in terms of our Medicaid budget versus other states? We hear constantly that we spend all this needless money on administrative costs of Medicaid. But, in terms of our Medicaid budget, where do we rank? And my next question…do we simply have more Medicaid recipients in NC in relation to other states? Is NC’s average spending per Medicaid enrollee grossly higher or lower than the national average?
Inquiring minds want to know!
Surprisingly, at least to me, Alaska has the highest average spending per Medicaid enrollee: $13,073, on average, per enrollee. But then I thought about, much of Alaska is rural…not only rural , but almost impossible to navigate due to the snow and ice. I don’t know for sure, but I would imagine that getting to and from Medicaid recipients or getting recipients to services (while not always reimbursed by Medicaid) must impact some of the costs.
[Important to note: The average spending per enrollee, to my knowledge, does not mean actual money spent per enrollee. I believe the authors took the total budget and divided it by the number of enrollees. So the average spent per enrollee includes built-in, administrative costs.]
Or…Maybe Alaska has a low number of Medicaid recipients and that is why Alaska spends the most per enrollee…maybe Alaska has a huge Medicaid budget without many recipients on which to spend it…few people, big pie…
I looked.
Alaska had, in 2012, 109,000 Medicaid recipients.
The fewer people you have at Thanksgiving, the bigger the pie pieces. However, interestingly enough, Alaska spent $1.425 million total in Medicaid in 2012. Delaware spent $1.421 in Medicaid in 2012. (Close enough, right?). Yet, Delaware spent $6831, on average, per enrollee. Maybe the pie analogy doesn’t work. Maybe sometimes, even with a big pie and few people, too many rats and ants nibble at the pie.
Out of 50 states, where do you think NC falls? Top 10 highest spender? Bottom 10? Right in the middle?
Drum roll……..
#9.
The only 8 states that spend more than NC per Medicaid recipient are:
1. Alaska
2. New Jersey (somehow that did not surprise me) ($11,433/recipient)
3. Rhode Island (that did surprise me…I mean, look how little RI is…how big a Medicaid budget can it have?) ($11,080/recipient)
4. North Dakota (a less populous state (less tax dollars), I believe) ($10,969/recipient)
5. Pennsylvania ($10,835/recipient)
6. Minnesota (there are big cities there (more tax dollars), no surprise) ($10,080/recipient)
7. Missouri (I went to law school in Missouri. This number surprised me a bit). ($10,022/recipient)
8. Connecticut ($9883/recipient)
9. NC ($9,430/recipient)
Crazy! What about Illinois? With the hugely populous, Windy City and it being Obama’s home state, surely, Medicaid spending per recipient is, at least, in the middle, right?
Wrong. Illinois is dead last with only $5229, on average, per recipient being spent.
Probably because too many people were invited to Thanksgiving…in 2012, Illinois had 2.626 million Medicaid recipients enrolled….or too many rats and ants.
Compare to NC in 2012 – 1.471 million Medicaid recipients.
What was Alaska’s Medicaid budget/spending in 2012 that the average spending per enrollee was $13,073?
$1.425 million spent. Up 10.3% from 2011. And 109,000 Medicaid enrollees.
Here is NC:
Spending: $13.872 million. Up 22.8% from 2011. And 1.471 million recipients.
Here is a crazy one..Nevada:
In 2012, Nevada had 301,000 Medicaid enrollees. A little under 3x Alaska. Nevada spent $1.692 million on Medicaid (only 200,000-ish over Alaska), but Nevada’s average spending per enrollee was $5,621 (less than half of Alaska and the third lowest amount spent per enrollee). Where did all Nevada’s Medicaid money go?? Rats and ants eating away the pie?
North Dakota has the very least number of Medicaid enrollees in 2012…66,000. Wyoming is a close second with only 67,000 Medicaid enrollees in 2012.
North Dakota was the 4th highest state as to spending per enrollee with an average of $10,969/enrollee.
Wyoming was the 16th highest state as to spending per enrollee with an average of $8537/enrollee.
Guess which state had the highest total spending on Medicaid in 2012?
Drum roll…..
California. (Shocker!). California spent $47.726 million on Medicaid, up 4.2% from 2011. California also had the highest number of enrollees on 2012 with 2.624 million enrollees (over a million more than NC). California also spent the 5th lowest on average per enrollee, $6,065.
Having a high number of enrollees did not always have a direct correlation with spending the least, on average, per enrollee. Oregon only had 569,000 Medicaid enrollees in 2012 and spent the 4th lowest amount, on average, per enrollee, $6,007.
New York is the closest state to spending and number of recipients to California, but New York succeeded in a much higher average spending per enrollee than California.
New York spent $39.257 million total on Medicaid (less than $8 million difference from California) in 2012. New York had 5.004 million enrollees (2.8 million Medicaid enrollees less than California) and spent, on average, $7845/enrollee (absolute, dead-on-middle as compared to all states).
Georgia is, perhaps, the most comparable to North Carolina in terms of number of Medicaid enrollees in 2012. NC = 1.471 million enrollees in 2012. GA = 1.529 enrollees in 2012.
NC spent $13.872 million, while Georgia spent $8.497 million in 2012. So, Georgia had MORE Medicaid enrollees and spent over $5 million less……
Is that good or bad? Is Georgia more efficient? Did Georgia spend less in administration costs?
Actually (albeit there may be other factors), Georgia spent significantly less, on average, on each Medicaid enrollee.
Georgia spent 2nd lowest, on average, per Medicaid enrollee. Only Illinois surpassed Georgia in lowest spending, on average, per enrollee. Georgia spent, on average, $5,229 per enrollee.
NC spent $9430, on average, per enrollee. (Which, BTW, is more than enough for my “A Modest Proposal”).
That is a huge difference!
One other number jumped out at me when I reviewed Modern Healthcare‘s article, “Medicaid Budgets By State.” Remember I told you that NC spent $13.872 million on Medicaid in 2012…and that the amount spent was a 22.8% increase from 2011?
22.8% is a high percentage to increase in only one year!
I looked at the increases/decreases of the states. North Carolina gets the award for the highest percentage growth in spending on Medicaid in the entire nation. NC was the only state whose percentage “increase of Medicaid spending” percentage from 2011 to 2012 was in the 20s.
NC is #1 in the nation for percentage increase as to total Medicaid spending!!!! (Proud?)
The next state with the highest increase in spending on Medicaid is Mississippi with a 17.4% increase in spending from 2011. Next in line is Alabama with a 14.7% increase in Medicaid spending.
Guess which states decreased its Medicaid spending the most from 2011 to 2012?
Drum roll…
Oregon (decrease of 23.2% spending) and Illinois (decrease of 15% spending). Is it coincidental that Illinois spent the absolute least, on average, per Medicaid recipient and that Oregon spent the 4th lowest, on average, per Medicaid recipient?
Regardless the size of the pie, the number of guests, and the number of rats and ants, we need to make sure that the guests (Medicaid recipients) are benefitting most from the pie.
Sometimes a decrease in spending equals a decrease in services to Medicaid recipients…sometimes not…I guess it depends on the number of rats and ants.
Wanted: North Carolina Medicaid Director: Transparent and Open!
With Carol Steckel’s abrupt resignation September 27, 2013, only 8 months after accepting the job as NC Medicaid Director, we North Carolinians were left without a Medicaid Director. I posted a week or so ago that I can only imagine how difficult it would be to fill the position, considering the absolute mess the Department of Health and Human Services (DHHS) has created recently…the calamity of NCTracks…the negative PR…the high salaries of administration…Who would want to inherit this mess???
While I cannot imagine the person who would actually apply to be our Medicaid Director in the midst of such storms, I do have some advice for whomever attempts to carry the burden of being NC’s Medicaid Director.
I don’t know why Ms. Steckel left. I’ve heard numerous hypotheses. I’ve heard that she didn’t get along with Sect. Wos. I’ve heard that she left because the NC Medicaid system cannot be fixed. I’ve heard the bad media press upset her. I’ve heard she couldn’t handle the scrutiny of the public.
Regardless, anyone who is thinking of applying to be our Medicaid Director needs to understand that this is a public servant job. This is not a private sector job. Why is that important? Because as an officer in the public arena, you are accountable to the taxpayers. You cannot hide behind rhetoric or stop speaking to media. As a public servant, you have duty to be transparent to taxpayers. You will be scrutinized by the public…and this is allowed.
Recently, Secretary Wos responded with this comment when asked about transparency… “I think the word transparency can get pretty dangerous. … If transparency means that we’re in a planning process and you’re asking us, ‘Tell us all the things you’re planning,’ well, my goodness, allow us to work, and then we’ll give you everything that you want.”
While I understand Sect. Wos’ assertion that if all we do is talk then nothing gets done, in the public sector, transparency is, not only desired by taxpayers, but public servants owe a duty to be transparent. Public servants are not spending their own money. It’s my money and your money. We deserve to know how our money is being spent and we deserve to have an opinion as to whether our money is being spent in an economically intelligent fashion.
For example, my blog about the managed care organizations paying the health insurance for its employees and the employees’ families was to point out that our tax dollars are paying for these employees’ families’ health insurance…tax dollars that are meant to provide health insurance to our most needy population.
Similarly, all the media hype about the high salaries of the two 24-year-old staffers, who were given salaries making $85,000 or more, the media are angered because, again, those salaries are paid by us.
Because the money that the Department of Health and Human Services (DHHS) spends is our money, not private funds, transparency is essential.
A few weeks ago, when I flew to New Mexico, I had to go through airport security. I had to take off my shoes (yuck! and walk on the airport floor), place my purse and laptop on the conveyor belt and step into the “All-Seeing Machine.” You know, the machine that you have to place your feet a little apart and raise your hands above your head, while the machine whirls around your body. I always feel slightly mortified every time I have to go through that machine. I even suck in my breathe a little so my belly doesn’t poke out. It is just a strange feeling to have a stranger look that closely at you and scrutinize your body. You never know what the person looking at your image is thinking. Being scrutinized is not fun.
Similarly, as NC Medicaid Director, and a public servant, you will be scrutinized. Every word. Every action…and non-action.
Remember Mary Poppins? Remember the sweet, little song the two children sang about the criteria for their new nanny?
If you want this choice position
Have a cheery disposition
Rosy cheeks, no warts!
Play games, all sort
You must be kind, you must be witty
Very sweet and fairly pretty
Take us on outings, give us treats
Sing songs, bring sweets
Never be cross or cruel
Never give us castor oil or gruel
Love us as a son and daughter
And never smell of barley water…
Well it applies to the Medicaid Director position too. Here is the “Perfect NC Medicaid Director Song:”
If you want this choice position Have an open disposition Know Medicaid laws and rules Don’t treat media as fools You must be strong, you must be smart Very tenacious, open heart Take on naysayers, show guts Move our Agency out of ruts Be transparent, don’t circumvent Never say to media, “No comment.” Love our citizens; our state And always, always update…I found the job posting for our Medicaid Director on the National Association of Medicaid Directors’ (NAMD) website.
Here it is:
DIRECTOR OF MEDICAL ASSISTANCE
The North Carolina Department of Health and Human Services (DHHS), in collaboration with our partners, protects the health and safety of all North Carolinians and provides essential human services.
Within DHHS, the Division of Medical Assistance (DMA) provides access to high quality, medically necessary health care for eligible North Carolina residents through cost-effective purchasing of health care services and products. The Department of Health and Human Services and DMA are devoted to quality customer service.
The Director of Medicaid directs the administration of the state’s Medicaid and NC Health Choice Programs. The Medicaid program serves more that 1.7 million North Carolinians and provides services to children, the elderly, the blind, the disabled and those eligible to receive federally funded assisted income maintenance payments. The North Carolina Health Choice (NCHC) Health Insurance Program for Children is a comprehensive health coverage program for low-income children. The goal of NCHC is to reduce the number of uninsured children in the State. The program focus is on families who make too much income to qualify for Medicaid but not enough to afford private or employer-sponsored health insurance.
DMA has approximately 400 employees and a budget impact of 14 billion dollars which includes 3.8 billion in state appropriations. DMA partners with over 78,000 physician providers throughout the state to provide essential services to recipients. The Director is responsible for multi-million dollar contracts and performs an array of fiscal agent and administrative services which include cost reimbursement and integrated payment management reporting to local management entities (area mental health programs). The position manages the state waiver program and demonstration projects. The Director is the primary interface with the Federal Centers for Medicare and Medicaid Services (CMS) and for the Committee Management Office. (CMO)
KNOWLEDGE, SKILLS AND ABILITIES:
Prior leadership and policy role in large complex organization administering the Medicaid Program or within a Medicaid Reimbursement or Health Insurance Agency
Demonstrated knowledge of the federal and state funding process for Medicaid and Medicare
Proven ability to build consensus among diverse stake holders which includes constituents, providers, advocacy groups, the media, the public and the legislature
Demonstrated ability to provide leadership during a time of change or reorganization
MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS:
A Masters Degree in Business, Public Health, Health Administration, Social or Clinical Science or a related field and six years of broad management experience in Health Administration or in Healthcare financial management of which at least three years must be at the Director or Assistant Director level of a statewide or federal division in Health Administration or Financial Management.
To be considered for this opportunity please submit a detailed resume to alma.troutman@dhhs.nc.gov
To learn more about the North Carolina Department of Health and Human Services, please visit our web site at: www.ncdhhs.gov
All applications will remain confidential.
Equal Opportunity Employer
Nowhere in the advertisement for the NC Medicaid Director does it say what the Medicaid Director ACTUALLY has to do in real life.
Undergo scrutiny. Talk to the public. Maintain transparency. Be a public figure in a time of crisis.
It’s our money. So talk to us.
NC Taxpayers Demand Accountability as to Behavioral Health Care Medicaid Funds (And That Medicaid Recipients Reap the Benefit of Such Funds).
I ask you, why do employees of an MCO receive better health care plans with Medicaid dollars than a Medicaid recipient with Medicaid dollars?
The State of North Carolina is accountable to me, and every taxpaying citizen, for taxes spent.
Similarly, executives of a corporation owe a duty to shareholders to account for stock crashing. Remember Enron? What a disaster!
Enron has been dubbed the biggest audit failure. Enron shareholders filed a $40 billion law suit after the company’s stock price, which achieved a high of US$38.44 per share in mid-2000, plummeted to less than $1 by the end of November 2001. And why did the shareholders sue? Because they lost money? Well, yes, but it is much more. The reason the shareholders lost money is because the executives of Enron owed a duty to the shareholders, basically, to be accountable to report correct data on financials.
Apparently, Enron’s financial statements were complex and confusing to shareholders. It has been said that from 1997 until its demise, “the primary motivations for Enron’s accounting and financial transactions seem to have been to keep reported income and reported cash flow up, asset values inflated, and liabilities off the books.” Bodurtha, James N., Jr. (Spring 2003). “Unfair Values” – Enron’s Shell Game. Washington, D.C.: McDonough School of Business. p. 2. CiteSeerX: 10.1.1.126.7560. Arthur Anderson was the audit and accounting firm, which also went belly up due to Enron. But Enron’s financials were false and, ultimately, led to numerous convictions.
Now, I am certainly NOT comparing the State of North Carolina to Enron. I am merely providing an example of a possible result when accountability is ignored. When the fiduciary duty owed is not fulfilled.
Not completely unlike corporate financials, North Carolina creates a budget every fiscal year (yeah, I get it, not completely similar either).
When the Medicaid budget is created each year, which is more than $18 billion, I, as a taxpayer, expect those Medicaid dollars allocated to the Medicaid budget to be spent for the benefit of Medicaid recipients. Medicaid money should be spent on Medicaid providers, who service Medicaid recipients. I expect that administration costs be kept at a minimum. I expect that Medicaid providers receive timely, prompt payments, and I expect that Medicaid recipients receive good, quality, and continuing health care.
I do not expect the State to cover the health care for everyone. Not even most people. I understand that funds are not limitless in government and that there must be limitations on spending, otherwise our great State will become another Detroit.
However, I do expect that the funds that ARE allocated to Medicaid to BE allocated for the benefit of the Medicaid recipients. Period.
In the past year, we have implemented the Managed Care Organizations (MCOs) to manage Medicaid behavioral health care. In theory, the MCOs were implemented to cut down the administrative costs for DHHS. Basically…outsourcing. In theory, it sounds good.
DHHS’ administration costs are out-of-control. After the January 2013 Performance Audit on DHHS, State Auditor Beth Wood said North Carolina’s administrative costs are 38 percent higher than the average of nine states because of “structural flaws” in how DHHS operates the Medicaid program.
So, in response to these high administrative costs (among other things), we took the administration of behavioral health from DHHS and delegated that administration to the MCOs. With the number of employees in Health and Human Services over 17,000 employees and the average MCO employing only a couple hundred, it seems, on its face, to be a good idea. Surely these MCOs can and will run more efficiently that the government! Right?
(The other assumption in outsourcing is that DHHS administrative costs would actually decrease due to the MCOs, but I have seen no indication of this). I have seen no indication of the “structural flaws” in how DHHS operates the Medicaid program being fixed.
According to the website indeed.com, the average salary for a person working at NC DHHS is $47,000. In addition to the average salary, you also need to contemplate that employees of NC DHHS qualify for basic health benefits at no cost. However, if a DHHS employee wants to have his or her spouse covered or an insurance plan above the “basic plan,” there is a nominal cost. (The standard plan (above a basic plan) for an employee is still low, only $22.76/mo).
Health insurance premiums are a HUGE expense. So when calculating salaries, if an employee receives free health care, in essence, the salary is higher…due to not having to pay premiums every month. Health care premiums add up. For example, I pay $750.00 monthly for health insurance for me and my husband. That’s $9000/year! Yikes!! (No, for real, yikes!!) If Williams Mullen paid my health insurance premium, in essence, my salary would increase by $9000/year.
Including health care and trying to underestimate instead of overestimate, I calculate the average salary, including health care premiums, at NC DHHS at about $52,000-ish.
Since the MCOs went “live,” the Medicaid tax dollars that would have been held by NC DHHS, are now divvied up and bestowed upon each MCO. Today, we have 11 MCOs, but soon Smokey Mountain Center will take over Western Highlands, bringing us to 10 MCOs. Plus, according to a recent article published, “Frustrations With MeckLINK Grow as Denials for Care Increases,” MeckLINK is financially unstable. We may soon be down to 9. But, as for now, 11 MCOs receive the federal and state tax dollars for Medicaid behavioral health.
Key point? Tax dollars.
CenterPoint Human Services (CenterPoint), one of the MCOs, staffs approximately 200 employees (about 19 part-time). Out of the 200-ish employees, 41 employees receive salaries over $75,000 (including health care). Almost 1/4 of CenterPoint’s employees have salaries OVER $75,000.
145 employees receive salaries over the NC DHHS average salary: $52,000.
Let’s talk about the price of health care. Remember, these are OUR tax dollars.
Employee A has a base salary of $45,500. But A received $16,965 in medical contribution. Remember, my insurance for me and my husband costs $9,000/year. For $16,965, how big of a family are we taxpayers covering?
Employee B has a base salary of $43,500. (Now, let me preface this example with…I hope…I pray…that this one example is a typo on CenterPoint’s financials, because, if not, this is outrageous!). According to CenterPoint’s financials, Employee B gets $84,658 in medical contributions. Including FICA contribution, dental, short and long-term disability, 401K, etc., Employee B receives $136,716 in total compensation. Admittedly, I have no way to confirm whether this is a typo….and, I must admit, I really hope it is. Regardless, according to CenterPoint’s financials Employee B receives $84,658 in medical contributions for a total of $136,716 total compensation, but with a base pay of only $43,500.
But here it is in black and white (and yellow) (toward the bottom):
Three other employees, C, D, and E, have base salaries of $49,750, $49,000, and $47,100, respectively, and medical contributions of $12,007 each. And here I thought MY health insurance was expensive…
The number $12,007 is popular. 12 employees in total receive $12,007 in medical contributions for a total of $144,084 (for 12 employees).
Another employee gets $16,965 in medical contribution with a base salary of $47,100.
Now let’s talk about the Medicaid recipients’ behavioral health care services.
Since the MCOs went live, it is indisputable that less behavioral health services are being authorized by the MCOs. (Why the government has not addressed this tragedy, I do not know). Another question is how many less behavioral health care servies? I have my suspicions that if we were shown the number of behavioral health care services authorized last year compared to this year, the line would look like \.
Remember the chart from yesterday?
And this chart only shows one county. One MCO.
NC DHHS is handing over millions (just the behavioral health portion of the Medicaid funds) of Medicaid dollars to the MCOs. But the money is not going to service Medicaid recipients. The Medicaid dollars are paying salaries at every MCO, as well as the employees’ families’ health insurance plans. What Medicaid funds go to the recipients for medically necessary services? Seems to decrease every day.
I ask you, why do employees of an MCO receive better health care plans with Medicaid dollars than a Medicaid recipient with Medicaid dollars?
Aren’t Medicaid funds supposed to be for Medicaid recipients?
Maybe instead of all this administrative waste, we should just buy private health insurance for all Medicaid recipients. It would probably be cheaper. And the medically necessary services would
NOT
LOOK
LIKE
THIS.
Going back to the State of North Carolina’s accountability to me and all taxpayers as to Medicaid tax dollars spent, I have not seen any investigation as where the behavioral health care Medicaid money is being spent.
The same article from above stated something that made me extremely concerned. In “Frustrations With MeckLINK Grow as Denials for Care Increases,” the article cites that “[o]nce MCOs took over, North Carolina stopped tracking what care patients are receiving. A health official said the database goes blank. That means the state does not know how many North Carolinians received services, what those services were, or what was denied. It can compare MCOs financials, but not their care.” (emphasis added).
Are you kidding me? The State of North Carolina, which is accountable to me and all taxpayers, cannot determine whether the Medicaid dollars being handed over to the MCOs are being used appropriately????
Yet 145 employees at CenterPoint receive salaries over the NC DHHS average salary: $52,000! 145 out of 200-ish, to be exact. Some employees are receiving health insurance contributions of over $10,000/year…and NC cannot determine how many Medicaid recipients received medically necessary behavioral health care??
As a taxpayer, I am appalled. And I want accountability!!
Where is the fiduciary duty to taxpayers?
NC Medicaid MCOs: You Cannot Prove a Negative!
In philosophy, you learn about “evidence of absence.” It’s kind of like a logical assumption based on the LACK of evidence. Such as: P implies Q is false, but Q is false, therefore P is false. Or Knicole takes a break from blogging on the weekends. Knicole did not blog today, therefore it must be a weekend.
There is also some who say you cannot prove a negative. You cannot prove that flying reindeer do not exist; it is up to the flying reindeer to prove they do exist. Personally, I think this way of thinking is pessimistic and leaves little room for faith. But, in some circumstances, such as…how are my tax dollars being used for Medicaid recipients, I do not want a non-proven negative. I want proof.
Recently, WFAE, Charlotte’s NPR News station, ran a piece entitled, “Frustrations with MeckLINK Grows as Denials for Care Increase.”
The point of the article was the drastic decrease in behavioral health service authorizations within MeckLINK’s catchment area (Mecklenburg county) for Medicaid services since MeckLINK went live.
Here is the chart WFAE provided in its article:
If this graph is correct, MeckLINK has some serious questions to answer to taxpayers. Within 4 months, the number of mental health Medicaid consumers in Mecklenburg county decreased OVER HALF??!!! From 1,518 to 689!
Did the 829 people, who were receiving mental health services back in February/March 2013, move from Mecklenburg county/die/heal (in order to not need the mental health services in June)? Or has MeckLINK (and other MCOs) simply begun to deny medically necessary mental health services???
If it is the latter and not the former, I ask, as a taxpayer, where did my Medicaid tax dollars go? To MeckLINK salaries? And, if it is the latter and not the former, as a person concerned with mental services, especially for Medicaid recipients, I ask, what has happened to the 829 Medicaid recipients no longer receiving mental health services?? Hospitalization? Incarceration? Homelessness? Or just sitting at home depressed…unable to function as they could when they did receive services?
Well, Ben Bradford, of WFAE, asked MeckLINK’s chief financial officer, Ken O’Neil, this question.
O’Neil’s answer? The evidence of absence.
O’Neil revealed that MeckLINK is on tenuous financial footing. It ran a deficit in May and June at a rate that would put it out of business in less than a year. He also argues those deficits are proof that MeckLINK isn’t sacrificing care for profit.
See Article.
O’Neil argues that MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit. Proof that flying reindeer do not exist!
O’Neil contends that MeckLINK’s deficit proves that MeckLINK is not denying medically necessary services to mentally ill Medicaid recipients. BTW: O’Neil contends this non-proven negative despite the graph showing that more than half of recipients in Mecklenburg county are no longer receiving services.
O’Neil’s contention (that a deficit proves MeckLINK is not sacrificing care for profit) has a gaping, logistic flaw.
Remember my blog, published June 10, 2013? “Higher Medicaid Administrative Costs = Less Medicaid Money for Providers to Service Recipients”
In this blog, I wrote about CenterPoint’s “hefty salaries to its top-executives. In addition to these hefty salaries, CenterPoint pays for all employees’ health insurance, as well as the health insurance for all employees’ families!!”
I estimated (and probably underestimated) that CenterPoint, by paying for its employees and employees’ families’ health premiums, was spending approximately $1.5 million in health care premiums…money that should have gone to Medicaid recipients.
So MeckLINK’s (O’Neil’s) contention that MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit is flawed. Where is the proof that MeckLINK is not over-paying its top executives? Where is the proof that MeckLINK is not over-spending on its employees, i.e., paying for employees’ health care premiums…as well as the families of employees?
Well, I found a few graphs published by DMA that caused me more reason to believe that O’Neil’s “proof of a negative” is flawed.
DMA issues reports on the MCOs. A recent dashboard report cites that, in its “Trends to Watch,”
1. Behavioral health related claims (e.g., Inpt MH, ICF/MR, CAP-MR and non-physician practitioners) continue to decline with the implementation of BH MCOs. Please note that several of the BH-related types of service have volatile costs per service unit and service units per recipient. This is a consequence of the drastic drop in utilization due to the implementation of MCOs and does not reflect a widespread trend. We will likely remove several of these types of service from the report soon.
I have SO many issues with this “trend.” Such as: “Continue to decline.” “With the implementation of BH (behavioral health) MCOs.” “Drastic drop in utilization.” “Due to the implementation of BH MCOS.” “Not reflect a widespread???” (Aren’t the MCOs statewide?). “We will…remove?… several of these services from the report”….WHY? We don’t want to track the fact that the mentally ill are not receiving Medicaid services?
The DMA Dashboard Report also depicts numerous graphs. Many of the graphs depict last fiscal years’ Medicaid services’ dollars spent (with a blue line) and this years’ Medicaid services’ dollars spent (with the red line).
Most years, both last fiscal year and this fiscal year, are fairly similar.
Such as Medicaid physicians’ office visits:
Notice the interplay between the red and blue lines. The expenditures for physicians’ office visits from last fiscal year to this fiscal year is, relatively, similar.
Now let’s look at a behavioral health service (ICF/MR):
See the difference?
The blue line depicts last fiscal year. The red line depicts the current fiscal year. The left side of the graph shows dollars, while the bottom side shows months.
As you can see, the blue line (last fiscal year) shows a semi-constant, horizontal line with a small down tick in April 2012. The red line, however, (this fiscal year) begins where the blue line left off, but, then, in January-ish 2013, a massive decrease in dollars spent.
So….a massive decrease….surely the MCOs were not paid the same…oh, and surely not more!!!???
Because, remember, if an MCO has a deficit, that means that the MCO is “not sacrificing care for profit.”
Here is DMA’s graph on MCO capitation payments per 1000 eligibles:
Now, mind you, I am no math expert, but this chart, to me, appears to show a 700% plus uptick in MCO capitation payments.
So, according to O’Neil, MeckLINK is running at a deficit, at least for a couple of months. Yet, DMA’s graphs demonstrate a decrease in mental health services and an increase in payments to MCOs.
Hmmmm.
Here are proofs of negatives:
The fact that Knicole did not blog today proves that it is a weekend. (Surely, Knicole was not just too busy on a weekday to get out a blog).
MeckLINK’s deficits are proof that MeckLINK is not sacrificing care for profit. (Surely, MeckLINK did not pay hefty salaries to top executives or all health care premiums for employees and families).
You cannot prove a negative. But you CAN show proof.
